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.
NCLEX-RN TEST FORMAT
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
- remain stationary
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.
TAKING THE NCLEX-RN CAT
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 CLIENT NEEDS
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% 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, 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% 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% of the exam. Nursing actions tested include the Aging Process, Ante/Intra/Postpartum and Newborn Care, Developmental Stages and Transitions, Disease Prevention, Health Screening, Lifestyle Choices, Physical Assessment Techniques, Health Promotion Programs, High Risk Behaviors, and Self-Care.
The third Client Needs Category is Psychosocial Integrity. It accounts for 6-12% 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.
The final Client Needs Category is Physiological Integrity. It includes four concepts:
Basic Care and Comfort accounts for 6-12% 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% of the exam. Tested nursing actions include Adverse Effects, Contraindications, 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% 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% 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.
HOW TO REGISTER FOR THE NCLEX-RN
About 6 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.
NCLEX-RN QBank Highlights
UWorld’s innovative, content-rich rationales, paired with vivid illustrations and images, detail the clinical reasoning behind the correct and incorrect answers. Understanding the “why” prepares you for any question about that subject matter, so you can be confident walking into your NCLEX exam