Navigating the NCLEX

October 13, 2021

Navigating the NCLEX

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What to Expect & Tips for Success

The National Council Licensure Examination (NCLEX) was created by the National Council of State Boards of Nursing (NCSBN) and is taken by more than 250,000 nursing candidates every year. Two versions of the test exist, the most popular being the NCLEX-RN for aspiring registered nurses. Prospective licensed practical nurses, also known as licensed vocational nurses in California and Texas, take the NCLEX-PN. Because successful passage is required to practice nursing, it’s not to be taken lightly. The following comprehensive guide helps nursing candidates be better prepared for the NCLEX while also highlighting recent changes to the format and testing procedures.

What You Should Know: NCLEX Basics

Before delving into the nitty-gritty details, this introductory section covers the basics by providing a brief summary of testing requirements, registration processes and exam administration.

What are the Differences Between The NCLEX-RN and The NCLEX-PN? Graduates of registered nursing programs take the NCLEX-RN to become licensed, whereas graduates of practical or vocational nursing programs take the NCLEX-PN. The two exams share almost the exact same categories, but the complexity of questions differs. Although there is some overlap in the test questions in areas where RNs and LPNs have the same duties, each exam focuses on the skills needed for that particular nursing discipline. RNs have more responsibilities in the four steps of nursing – assessment, planning, implementation and evaluation – and this is reflected in the questions included on the exam. Since RNs perform more complex tasks, including invasive procedures, they are tested on the skills needed to perform those duties. LPNs, who work under the supervision of a managing RN, will need to be well-versed in questions about coordination with nurses and communication with patients.
What are the Requirements for Taking the NCLEX? Requirements to sit for the exam are set by each state’s nursing board or a comparable regulatory body. Most require examinees to be graduates of an approved nursing program, but there may be other state-specific mandates as well. Texas, for instance, requires a criminal background check and completion of a 50-question exam on nursing jurisprudence. Aspiring nurses should check with their state nursing board prior to applying.
How Do I Register for The NCLEX? Examination applicants should contact their state’s board of nursing or other regulatory body and request a licensure/registration application to start the process. Requirements vary by state.
How Much Does The NCLEX Cost? The approximate cost of the test is $200 as of January 2016, but state-determined licensure fees are not included in that amount. In Oregon, this fee is $169 for first-time test takers and $25 for each subsequent attempt. Students must pay the licensure fee when they send in their application, while the testing fee can be brought to an approved Pearson VUE testing center. Students should register with Pearson VUE and their state board of nursing at roughly the same time.
Where Can I Take the Test? Pearson VUE administers the NCLEX at locations across the United States and in Canada. It also has international testing sites, although international candidates must pay an additional $150 scheduling fee.
When and How Often is The Test Offered? Pearson VUE administers the NCLEX continuously throughout the year. Candidates schedule an appointment with the testing center and are given a date within the following 30 days. The time period for repeat candidates is no less than 45 days.

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Testing

Once a student understands testing basics and procedures, the next step is to complete the examination. The following section provides a short preparation timeline, information about test scores, and details on rescheduling and retaking the exam.

Preparation Timeline Creating a study schedule is a key component of success when it comes to the NCLEX. Some of the best advice for examinees looking to complete the exam in the next few months include: Get to know your strengths and weaknesses two to three months before the exam by completing a comprehensive test, then taking practice tests in areas where you score the lowest.
Study for one to two hours a couple times per week Throughout the month prior to the exam, take three to four comprehensive tests. A week before the exam, do a final review and take the original comprehensive test to gauge improvement. On the day of the exam, get to the testing center an hour early. If necessary, consider staying in a hotel. Remember to breathe! Rather than trying to calculate your score, focus on answering questions correctly.
Scores Forty-seven U.S. states and territories participate in Pearson’s Quick Results Service, which allows candidates to pay $7.95 and receive their unofficial results within two business days. Official results are sent about six weeks after the exam.
Rescheduling Candidates can reschedule up until 24 hours before the exam. Each state board specifies the length of time a candidate can wait to take the NCLEX after receiving authorization, the average being 90 days. Students must reschedule within the time window allowed by their state board. If not, they must register and pay the exam fee again.
Retaking the Test The NCSBN mandates a minimum waiting period of 45 days to retake the test, meaning applicants could sit the exam up to eight times in a year, although some states institute longer waiting periods. Although the NCSBN does not limit the number of times students may retake the test, individual state boards may. Some states, such as Colorado, allow three attempts within three years. If a student doesn’t pass on their third try, they must attain a waiver. Other states, such as Arizona, allow applicants to retake the test as many times as needed. Florida splits the difference between these two approaches, making applicants take a refresher course if they fail three times.

Cost

Taking the NCLEX is an investment and students should budget for it ahead of time. The numbers below apply to both those taking the test for the first time and to those retaking it.

Test Cost Breakdown Candidates for licensure pay a $200 registration fee ($350 if taking the test abroad), and those who change state nursing boards after registering must pay an additional $50. Examinees who switch from NCLEX-RN to NCLEX-PN, or vice versa, will also incur an additional $50 fee. All of these costs are in addition to state licensing fees, which vary by individual boards.
Accommodations There is no fee for candidates who need special testing accommodations, such as having someone read the questions to them.
Refunds The NCSBN does not offer refunds.
Financial Assistance The NCLEX-RN and PN exams fees are reimbursable for veterans and their dependents. To receive these funds, veterans should check with their local Department of Veterans Affairs.

Although the contents of the NCLEX-RN and NCLEX-PN are quite different, the layout is similar. This section explains the four exam categories and their accompanying subcategories, and breaks down the content of each.

1. Exam Section One: Safe and Effective Caring Environment
This section evaluates test takers on their ability to both enhance the care setting and protect patients and staff from dangers. Two subcategories are included in this section:

Management of Care/Coordinated Care.

RNs answer questions in the management of care subcategory, which covers things like advance directives, client rights, case management, continuity of care, and informed consent. PNs answer questions in the coordinated care subcategory, which is similar to management of care but without principles such as case management.

Percentage of NCLEX-RN: 17-23 percent

Percentage of NCLEX-PN: 16-22 percent

Safety and Infection Control

Test questions cover injury prevention, handling of infectious materials, ergonomics, restraints, equipment use, and surgical asepsis.

Percentage of NCLEX-RN: 9-15 percent

Percentage of NCLEX-PN: 10-16 percent

2. Exam Section Two: Health Promotion and Maintenance
This section, which does not have any subcategories, covers both potential RNs and potential PNs and presents questions related to aging, care for mothers and infants, developmental stages, lifestyle, and self-care. The NCLEX-PN might ask about data collection, such as blood pressure and temperature, while the NCLEX-RN may ask about physical assessments and health screenings geared toward optimizing health outcomes.

Percentage of NCLEX-RN: 6-12 percent

Percentage of NCLEX-PN: 7-13 percent

3. Exam Section Three: Psychosocial Integrity
This section, which does not have any subcategories, covers patients’ emotional and mental states. Content includes dealing with substance abuse, understanding mental health, applying stress management techniques, providing palliative care, and creating a therapeutic environment.

Percentage of NCLEX-RN: 6-12 percent

Percentage of NCLEX-PN: 8-14 percent

4. Exam Section Four: Physiological Integrity
This section of the test deals with adult medical and surgical care, pediatrics and gerontology. Broken down into four categories, students will be questioned on topics such as traumatic injuries, skin disorders, birth abnormalities and child abuse.

Basic Care and Comfort

This section deals with mobility issues, nutrition and hydration, hygiene, sleep, waste elimination, and assistive devices.

Percentage of NCLEX-RN: 6-12 percent

Percentage of NCLEX-PN: 7-13 percent

Pharmacological and Parenteral Therapies/ Pharmacological Therapies

RNs have more responsibilities than PNs for administering medication, both intravenously and through the mouth or alimentary canal. Questions covered in this category include drug interactions and side effects, handling blood, giving injections, calculating doses, and managing pain. Candidates for the NCLEX-PN answer a smaller list of questions since they are not responsible for parenteral therapies.

Percentage of NCLEX-RN: 12-18 percent

Percentage of NCLEX-PN: 11-17 percent

Reduction of Risk Potential

This subcategory covers questions about minimizing complications stemming from a patient’s underlying condition or from therapies the patient is receiving. It includes questions about running diagnostic tests, assessing laboratory results, understanding complications from procedures, monitoring changes in vital signs, and applying therapeutic practices.

Percentage of NCLEX-RN: 9-15 percent

Percentage of NCLEX-PN: 10-16 percent

Physiological Adaptation

This subcategory deals with all the different changes to a patient’s physical condition that may take place in a hospital setting, including blood flow, electrolyte imbalances, allergic reactions, and emergencies.

Percentage of NCLEX-RN: 11-17 percent

Percentage of NCLEX-PN: 7-13 percent

The NCSBN uses a formula to calculate the passing standard, which is essentially the minimum knowledge needed for nurses to be competent. The NCLEX-RN is between 75 and 265 questions, while the NCLEX-PN consists of 85 to 205 questions. Examinees answering a question correctly receive a slightly more difficult question, and vice versa. Each question is weighted differently. Both exams are scored using an algorithm that measures whether the applicant meets the passing standard. The algorithm has determined that candidates who answer the first 75 questions correctly probably don’t need to answer any more to prove their competency, while those who incorrectly answer the first 75 questions probably won’t do much better by receiving more. Most applicants fall somewhere in the middle, and the computer assesses when it has enough information to determine if the applicant passed. The average number of questions in 2012 was 117 for the NCLEX-PN and 119 for the NCLEX-RN.

Exam Day: What to Expect

Before entering the testing space, applicants must have their photograph taken and submit a handprint for verification. They must also leave personal items in the break room, as there are strict standards about what may enter the exam room. Once inside, examinees take their seats at individual booths with computers. The test takes a maximum of five hours for PNs and six hours for RNs, although most applicants finish before the buzzer. Test takers are given a short survey once they finish the exam and are then allowed to leave. Below are a few other details about what to expect on exam day.

Final Preparation: What to Bring with You

Exam Period

Testing interruptions

Test takers can inform the TA of any interruptions or issues, some of which have exceptions:

End of the Exam: The Results

Although the exam is taken on a computer, all scores are verified by a human administrator before being issued and cannot be seen immediately. Applicants whose state boards of nursing participate in Pearson’s Quick Results Service can pay $7.95 to receive their unofficial results within 48 business hours. Official results for all candidates are sent roughly six weeks later. Applicants who do not pass the NCLEX receive a Candidate Performance Report. This document shows how close the applicant was to passing, and places the quality of the applicant’s answers into one of three categories: below, near or above the passing standard. Test takers can use this information to assess their weaknesses and create a targeted study plan for retaking the test. The NCSBN requires that candidates who do not pass wait 45 days to retake the test, although some states have longer waiting periods. The exam fees are the same as for first-time test takers, but state licensing fees may be reduced.

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