11.2 Preparing for the NCLEX

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the exam that nursing graduates must pass successfully to obtain their nursing license and become a registered 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-RN 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-RN 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 reestimates 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 11.1.^[4]

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^[5]:

• 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-RN 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

Next Generation NCLEX

A new edition of NCLEX will be released in 2023 with “Next Generation” questions. (If you take the NCLEX before the new edition is released, you may be asked to voluntarily participate in a special research section that tests the accuracy of these new types of questions without your performance counting toward your final score.)

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.^[6]

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.^[7]
• 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.^[8]
• 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.^[9]
• 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.^[10]
• 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.^[11]

Preparing for the Examination

Since the first day of nursing school, you have been working towards successfully passing the NCLEX-RN. After you graduate, it is important to implement strategies for success for taking the  NCLEX, such as reviewing the NCLEX-RN Test Plan, setting up a dedicated review schedule based on your test date, and reviewing material you learned throughout nursing school.^[12]

NCLEX Test Plan

The NCLEX-RN Test Plan provides a concise summary of the content and scope of the exam and serves as an excellent guide for preparation. NCLEX-RN 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.^[13]

The NCLEX Test Plan categorizes test questions based on categories and subcategories referred to as “Client Needs”^[14]:

• 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^[15]:

• Nursing Process
• Caring
• Communication and Documentation
• Teaching and Learning
• Culture and Spirituality

Review Schedule

Many students find it helpful to create and follow a study calendar with topics to review based on the NCLEX 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.^[16],[17]

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.

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.^[20]

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.^[21]

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.