12.2 Preparing for the NCLEX-PN
The National Council Licensure Examination for Practical Nurses (NCLEX-PN) is the exam that nursing graduates must pass successfully to obtain their license and become a licensed practical/vocational nurse. The purpose of the NCLEX is to evaluate if a nursing graduate (i.e., candidate) is competent to provide safe, competent, entry-level nursing care. The NCLEX-PN is developed by the National Council of State Board of Nursing (NCSBN), an independent, nonprofit organization composed of the 50 state boards of nursing and other regulatory agencies.[1]
The NCLEX-PN is a pass/fail examination administered on a computer using computer adaptive testing (CAT). CAT means that every time a candidate answers a test item, the computer re-estimates their ability based on all their previous answers and the difficulty of those items. The computer then selects the next item based on an estimated 50% chance of the candidate answering it correctly. In this manner, the next item is not too easy nor too difficult, and a candidate’s true ability level is determined. Each item is perceived by the candidate as challenging because it is targeted to their ability. With each item answered, the computer’s estimate of the candidate’s ability becomes more precise.
The computer stops providing items when it is 95% certain that the candidate’s ability is clearly above or clearly below the passing standard, the candidate has received the maximum number of questions, or the candidate has run out of time without demonstrating a competence level to pass. Testing accommodations may be provided for eligible candidates with the authorization of the candidate’s State Board of Nursing (SBON).[2],[3]
See an image of a simulated graduate taking the NCLEX in Figure 12.1.[4]
Read more about the NCLEX at NCSBN’s Examinations web page.
Watch a video[5] from the NCSBN about how the NCLEX uses computer-assistive technology (CAT): NCLEX Using CAT.
Registering to Take the NCLEX
Before you can register to take the NCLEX, you will need an Authorization to Test (ATT). To receive an ATT, complete the following steps[6]:
- Apply for a nurse license from your State Board of Nursing (SBON) or other nursing regulatory body
- Register with Pearson VUE and pay the exam fee
- Wait to receive your ATT from Pearson Vue
- Schedule your exam with Pearson VUE
Be sure to start this process well in advance of your target date for taking the NCLEX.
Read specific instructions regarding registering and taking the NCLEX-PN by downloading the most current NCLEX-Candidate Bulletin from the NCSBN. The content includes the following:
- Registering for the exam
- Scheduling the exam
- Understanding test site rules and regulations
- Preparing for the day of the exam
Download the most current NCLEX-Candidate Bulletin from NCSBN’s Examinations web page.
Next Generation NCLEX
A new edition of NCLEX was released in 2023 with “Next Generation” questions.
The Next Generation NCLEX (Next Gen) uses evolving case studies and new types of test questions based on a new NCSBN Clinical Judgment Measurement Model (NCJMM) that assesses how well the candidate can think critically and use clinical judgment when providing nursing care. The NCJMM assess the candidate’s ability to recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.[7]
Five new Next Generation test item types are called extended multiple response, extended drag and drop, cloze (drop-down), extended hot spot (highlighting), and matrix/grid:
- Extended Multiple Response: Extended Multiple Response items allow candidates to select one or more answer options at a time. This item type is similar to the current NCLEX multiple response item but has more options and uses partial credit scoring.[8]
- Extended Drag and Drop: Extended Drag and Drop items allow candidates to move or place response options into answer spaces. This item type is like the current NCLEX ordered response items but not all of the response options may be required to answer the item. In some items, there may be more response options than answer spaces.[9]
- Cloze (Drop – Down): Cloze (Drop – Down) items allow candidates to select one option from a drop-down list. There can be more than one drop-down list in a cloze item. These drop-down lists can be used as words or phrases within a sentence or within tables and charts.[10]
- Enhanced Hot Spot (Highlighting): Enhanced Hot Spot items allow candidates to select their answer by highlighting predefined words or phrases. Candidates can select and deselect the highlighted parts by clicking on the words or phrases. These types of items allow an individual to read a portion of a client medical record (e.g., a nursing note, medical history, lab values, medication record, etc.), and then select the words or phrases that answer the item.[11]
- Matrix/Grid: Matrix/Grid items allow the candidate to select one or more answer options for each row and/or column. This item type can be useful in measuring multiple aspects of the clinical scenario with a single item. In the example below, each of the eight rows will need to have one of the three answer choices selected.[12]
View a supplementary YouTube video[13] on Next Generation test items: The Right Decisions Come from the Right Questions.
Participate in an NCLEX tutorial at the Next Generation NCLEX’s Prepare for Success web page.
Preparing for the Examination
Since the first day of nursing school, you have been working towards successfully passing the NCLEX. After you graduate, it is important to implement strategies for success for taking the NCLEX, such as reviewing the NCLEX Test Plan, setting up a dedicated review schedule based on your test date, and reviewing material you learned throughout nursing school.[14]
NCLEX Test Plan
The NCLEX Test Plan provides a concise summary of the content and scope of the exam and serves as an excellent guide for preparation. NCLEX test plans are updated every three years based on surveys of newly licensed registered nurses to ensure the NCLEX questions reflect fair, comprehensive, current, and entry-level nursing competency.[15]
The NCLEX Test Plan categorizes test questions based on categories and subcategories referred to as “Client Needs”[16]:
- Safe and Effective Care Environment
- Management of Care
- Safety and Infection Control
- Health Promotion and Maintenance
- Psychosocial Integrity
- Physiological Integrity
- Basic Care and Comfort
- Pharmacological and Parenteral Therapies
- Reduction of Risk Potential
- Physiological Adaptation
In addition, the following concepts are applied throughout the client needs categories[17]:
- Nursing Process
- Caring
- Communication and Documentation
- Teaching and Learning
- Culture and Spirituality
Download the current NCLEX-PN Test Plan from Next Generation NCLEX’s Test Plans web page.
Review Schedule
Many students find it helpful to create and follow a study calendar with topics to review based on the NCLEX-PN Test Plan.
Reviewing Material
Some graduates prefer to attend an NCLEX review course to prepare for the examination whereas others prefer to review their notes from nursing school on their own. Be sure to review the NCLEX Candidate Rules before the day of the examination.[18],[19]
Day of the Examination
On the day of the examination, it is normal to experience some anxiety. However, it is important to use techniques to manage anxiety so it does not impact your ability to think through and answer the test questions. Use positive self-talk and remind yourself that you have been preparing for this examination since the first day of nursing school. Read additional tips for the day of the NCLEX and tips for testing in the following boxes.
| Tips for the Day of the NCLEX[20] |
|---|
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| Tips for Testing[21] |
|---|
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After the Examination
If your State Board of Nursing (SBON) or nursing regulatory body (NRB) participates in the “Quick Results Service,” you can receive your “unofficial” results two business days after the exam if you pay for this service. Official results are sent to you approximately six weeks after the exam.[22]
If you didn’t pass the exam, you’ll receive an NCLEX Candidate Performance Report (CPR). The CPR is an individualized document that shows how a candidate performed in each of the test plan content areas. Graduates who fail the exam can use the CPR as a guide to prepare them to retake the exam.[23]
If you need to retake the exam, you will need to wait a minimum of 45 days before you can retake the NCLEX per NCSBN policy. This length of time is determined by your SBON (or NRB) and will be reflected in your new ATT’s validity dates. Read the steps for retaking the NCLEX in the following box.
| Steps for Retaking the NCLEX |
|---|
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- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN Examinations. (2021). 2021 NCLEX examination candidate bulletin. https://www.ncsbn.org/candidatebulletin.htm ↵
- “Woman_with_computer.jpg” by Cumminsr at English Wikipedia is licensed under CC BY-SA 3.0 ↵
- NCSBN. (2012). NCLEX using CAT [Video]. All rights reserved. https://www.ncsbn.org/video/nclex-using-cat ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. (2019, December 17). The right decisions come from the right questions [Video]. YouTube. All rights reserved. https://www.youtube.com/watch?v=ZBXfkINlRF0 ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN Examinations. (2021). 2021 NCLEX examination candidate bulletin. https://www.ncsbn.org/candidatebulletin.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
- NCSBN. https://www.ncsbn.org/nclex.htm ↵
The exam that nursing graduates must pass successfully to obtain their license and become a licensed practical nurse.
Managing the Nursing Team
Managing care provided by the nursing team is an important skill of nurse leaders to ensure safe, quality, client-centered care in complex and often challenging health care environment. While many nursing students focus on developing clinical skills and knowledge during their educational journey, the importance of learning management and leadership skills should not be minimized. Newly licensed nurses in clinical practice often find themselves in situations requiring effective nursing leadership and management skills.
Nurses must first have a good understanding of the Nurse Practice Act (NPA) in the state in which they are employed to know their legal scope of practice, as well as the scope of practice of other members on the nursing team. The NPA contains regulations established by the state legislature that are enforced by the Board of Nursing. The Board of Nursing is the state-specific licensing and regulatory body that sets standards for safe nursing care and issues nursing licenses to qualified candidates. A good understanding of the state NPA ensures adherence to legal standards of care when performing, assigning, and delegating nursing responsibilities. Additionally, a clear understanding of the scope of each team member's role promotes an efficient and well-coordinated approach to client care.
A registered nurse (RN) is a nurse who has completed a required program of study (i.e., associate degree, diploma, or bachelor's degree), successfully passed the NCLEX-RN, and received an RN nursing license. The RN is considered the leader of a nursing team for an assigned group of clients. The RN follows the standards of care known as the nursing process (assessment, diagnosis, outcome identification, planning, implementation of interventions, and evaluation).
Licensed practical/vocational nurses (LPN/VNs) complete a state-approved practical nursing program, successfully pass the NCLEX-PN, and receive an LPN or LVN license. LPN/VNs perform basic nursing care for stable clients under the supervision of an RN. RNs may delegate nursing tasks to qualified, competent LPNs under specific situations.
Nursing assistants (NAs), a type of unlicensed assistive personnel (UAP), work under the supervision of LPN/VNs and RNs to whom a nursing responsibility may be delegated. In some states, nursing assistants must complete a state-approved nursing assistant training program and successfully pass the state competency evaluation to become a certified nursing assistant (CNA) to work in long-term care centers. NAs provide basic care and help clients with activities of daily living. They typically perform the following tasks:
- Measure and record clients' vital signs and other basic measurements like input/output
- Assist clients with activities of daily living (dressing, bathing, toileting, and eating)
- Reposition and transfer clients between beds, chairs, and/or wheelchairs
- Document client behaviors and report suspected changes in condition to nurses
Wisconsin Nurse Practice Act
Let's examine the roles and scope of practice for members of the nursing team according to the state-specific regulations in the Wisconsin Nurse Practice Act (NPA).
According to the NPA, a registered nurse (RN) "utilizes the nursing process in the execution of general nursing procedures in the maintenance of health, prevention of illness or care of the ill. The nursing process consists of the steps of assessment, planning, intervention and evaluation."[1]
The role of the licensed practical nurse (LPN) is defined as the "performance of acts in basic patient situations."[2] In the performance of acts in basic patient situations, the LPN shall, under the general supervision of an RN or the direction of a provider do the following[3]:
- Accept only patient care assignments which the LPN is competent to perform.
- Provide basic nursing care.
- Record nursing care given and report to the appropriate person changes in the condition of a patient.
- Consult with a provider in cases where an LPN knows or should know a delegated act may harm a patient.
- Perform the following other acts when applicable:
- Assist with the collection of data.
- Assist with the development and revision of a nursing care plan.
- Reinforce the teaching provided by an RN provider and provide basic health care instruction.
- Participate with other health team members in meeting basic patient needs.
In this description of the LPN role and standards of care, basic nursing care is defined as "care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable." A basic patient situation is defined as a situation "determined by an RN, physician, podiatrist, dentist, or optometrist that meets the following three conditions[4]:
- The patient’s clinical condition is predictable.
- Medical or nursing orders are not changing frequently and do not contain complex modifications.
- The patient’s clinical condition requires only basic nursing care.
The Wisconsin NPA further states that in the performance of acts in complex patient situations, the LPN shall meet these previously defined standards, as well as perform delegated acts beyond basic nursing care under the direct supervision of an RN or provider. A complex patient situation is defined as, "an act determined by an RN, physician, podiatrist, dentist, or optometrist where one or more of the following conditions exist in a given situation[5]:
- The patient’s clinical condition is not predictable.
- Medical or nursing orders are likely to involve frequent changes or complex modifications.
- The patient’s clinical condition indicates care that is likely to require modification of nursing procedures in which the responses of the patient to the nursing care are not predictable.
See Table 1.7a for a summary of educational preparation and scope of practice for RNs and LPNs according to Wisconsin's Nurse Practice Act, as well as an overview of tasks performed by certified nursing assistants (CNAs), a type of assistive personnel (AP).
Table 1.7a. Roles and Responsibilities of Nursing Team Members in Wisconsin[6],[7]
| Registered Nurse (RN) | Licensed Practical Nurse (LPN) | Certified Nursing Assistant (CNA) | |
|---|---|---|---|
| Education and Licensure or Certification | Completes an accredited nursing program (diploma, associate degree, or bachelor's degree) and successfully passes the NCLEX-RN. | Completes a state-approved practical nursing program and successfully passes the NCLEX-PN. | Completes a state-approved nursing assistant training program and successfully passes the state competency evaluation. |
| Scope of Practice |
|
|
|
When making assignments and delegating tasks to nursing team members, it is essential for a nurse leader to keep in mind specific tasks that can and cannot be delegated to other nursing team members based on federal and/or state regulations. For example, in Wisconsin the NPA states, "In the supervision and direction of delegated acts, an RN shall do all of the following:
(a) Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised.
(b) Provide direction and assistance to those supervised.
(c) Observe and monitor the activities of those supervised.
(d) Evaluate the effectiveness of acts performed under supervision"
Examples of tasks that generally cannot be delegated are described in Table 1.7b.
Table 1.7b. Examples of Tasks Outside the Scope of Practice of Nursing Team Members
| Nursing Team Member | Tasks That Cannot Be Delegated
|
|---|---|
| LPN/VN |
|
| Assistive Personnel (AP) |
|
As always, refer to the state Nurse Practice Act and other state regulations for specific details about nursing team members’ scope of practice in which one is employed.
Find and review Nurse Practice Acts by state at www.ncsbn.org/npa.
Read more about the Wisconsin's Nurse Practice Act and the standards and scope of practice for RNs and LPNs Wisconsin's Legislative Code Chapter N6.
Read more about scope of practice, skills, and practices of nurse aides in Wisconsin at DHS 129.07 Standards for Nurse Aide Training Programs.
Managing Client Care as a Member of the Interprofessional Health Care Team
Collaboration with other interprofessional team members is a key aspect of managing nursing care. Nurses work closely with physicians, therapists, social workers, and other health care professionals to develop and implement comprehensive care plans. Effective communication, coordination, and teamwork are essential to ensure that all members of the health care team are aligned in their efforts and contribute their expertise for the best possible outcomes for clients.
Nurses and charge nurses may participate in interprofessional team conferences where they contribute their insights, advocate for clients, and ensure that their needs are met holistically. They may also serve as liaisons when establishing community resources for clients being discharged home, ensuring a smooth transition and continuity of care.