NCLEX-RN and NCLEX-PN: What to Know Before You Study

Congratulations! You’ve got your nursing degree! With your diploma from an accredited college or university, you’ve made a huge step towards your dream of becoming a Licensed Nurse. You’re almost there!

Now, it’s time to study for your National Council Licensure Examination (NCLEX). You’ve already got a solid foundation of nursing knowledge and clinical skills. The NCLEX-RN and NCLEX-PN are standardized tests that indicate if you’re ready to begin your nursing practice.

Who oversees the NCLEX process?

NCSBN is the independent, not-for-profit, organization that is involved in the regulation of nurses. It’s a separate entity from the American Nurses Association (ANA) Council on State Boards of Nursing, which represents professional nurses.

Since 1978, NCSBN’s membership has been made of the boards of nursing and other nursing regulatory organizations charged with the responsibility of “providing regulatory excellence for public health, safety and welfare, and protecting the public by ensuring that safe and competent nursing care is provided by licensed nurses.” Members are from all 50 states, District of Columbia, and U.S. territories.

With that duty in mind, NCSBN develops “psychometrically sound and legally defensible nurse licensure examinations consistent with current nursing practice.” Every three years, a rigorous practice analysis review is conducted to ensure that the NCLEX is consistent with current entry-level nursing practice. For example, recommendations for the 2019 NCLEX-RN include questions about the care of the client experiencing grief and loss; handling and administering high-risk medications; and care of the client during procedures with mild sedation.

The outcome of the process is an outline of content that a new graduate and entry-level nurse must know in order to be considered minimally competent. The NCLEX-RN cycle produced a new test that was put into place April 1, 2019. The new NCLEX-PN test took effect April 1, 2020. You can learn more about the NCLEX-RN or NCLEX-PN test plans and download a copy here. The test plans are lengthy, but have valuable information for candidates.

How are the NCLEX questions organized?

Since 2001, there have been four major categories of Client Needs: Safe and Effective Care Environment; Health Promotion and Maintenance; Psychosocial Integrity; and Physiological Integrity.

Both NCLEX-RN and NCLEX-PN have subcategories under two major categories (Safe and Effective Care Environment and Physiological Integrity) for a total of eight areas of Client Needs. Each category has a designated percentage of content on the examinations. Nurse Plus has duplicated these percentages in our practice tests.

NCLEX-RN:

• Safe and Effective Care Environment
  • Management of Care 17-23%
  • Safety and Infection Control 9-15%
• Health Promotion and Maintenance 6-12%
• Psychological Integrity 6-12%
• Physiological Integrity
  • Basic Care and Comfort 6-12%
  • Pharmacological and Parenteral Therapies 12-18%
  • Reduction of Risk Potential 9-15%
  • Physiological Adaptation 11-17%

NCLEX-PN:

• Safe and Effective Care Environment
  • Coordination of Care 18-24%
  • Safety and Infection Control 10-16%
• Health Promotion and Maintenance 6-12%
• Psychosocial Integrity 9-15%
• Physiological Integrity
  • Basic Care and Comfort 7-13%
  • Pharmacological Therapies 10-16%
  • Reduction of Risk Potential 9-15%
  • Physiological Adaptation 7-13%

What about the questions on the NCLEX?

You’re probably nervous about what kinds of questions will be on the NCLEX. We have some good news: All of the questions are written based on the principles you learned during your education and clinical training.

When you study for the NCLEX, and take the Nurse Plus practice tests, you’ll be using the information and concepts that you’ve already learned:

• Biological Sciences: anatomy, physiology, biology, and microbiology
• Social Sciences: psychology and sociology
• Nursing Process
• Communication Skills
• Culture and Spirituality
• Teaching and Learning
• Caring

For RN candidates, content will also include information and concepts from:

• Physical Sciences (chemistry and physics)
• Communication and Documentation

Each question on the NCLEX, no matter what the category, must meet four criteria:

1. It must be accurate.
2. It must reflect current nursing practice.
3. It must be something an entry-level nurse could know.
4. It must be linked to a category in the test plan.

Why studying and taking practice tests matter

All candidates are encouraged to study before sitting for their NCLEX examination. Establishing a regular study schedule and using several methods can help you pass the first time. Research done by Duncan R. Godden and Alan D. Baddeley in 1975 demonstrated that studying in a similar manner and environment to the actual test results in better recall.

State-dependent memory (or state-dependent learning) means that we’re able to remember and perform better when we’re at the same level of consciousness as when we learn. If we’re comfortable and confident because we’ve practiced the examinations and know what to expect, our anxiety level will be lower on the day we sit for the test. We’re more likely to have a better outcome.

What is Computer Adaptive Testing?

When you sit for your NCLEX, you won’t be taking a test with the same number of questions, called test items, given to each candidate. Instead, NCSBN uses Computer Adaptive Testing (CAT), which adjusts both the number of questions and their difficulty for each candidate.

To understand CAT, here are a few helpful definitions:

• Candidate Ability -- The level of entry-level nursing knowledge, skills and abilities that the candidate has.
• Ability Estimate -- The level of entry-level nursing knowledge, skills and abilities that the computer has determined that the candidate has.
• Passing Standard -- A cut point along an ability range that marks the minimum ability level requirement. For the NCLEX, it is the minimum ability required to safely and effectively practice nursing at the entry-level.
• Logit -- A unit of measurement to report relative differences between candidate ability estimates and item difficulties.

Every time you answer a question (You’re not allowed to skip; you must give an answer in order to continue.) the computer recalculates your ability to answer the next question. It uses a formula that includes all your previous answers and how difficult they were. The computer then will choose a question that gives you a 50% chance of answering correctly. This means the new question shouldn’t be either too hard or too easy. Each question should be challenging, because the computer is tracking your ability. As the exam proceeds, it gets better and better at selecting questions.

The NCLEX-RN has 75-265 test items. NCLEX-PN candidates will have 85-205 test items. Both examinations include 15 test items that aren’t scored, but are being validated for future exams. You won’t know which these are as you go through the exam.

CAT will determine if you have passed or failed by one of three rules:

1. 95% Confidence Interval Rule: The computer stops selecting new items as soon as it is 95% certain that your ability is clearly above or clearly below the passing standard. This is the most common rule for NCLEX candidates.
2. Maximum-Length Exam Rule: When you’re very close to the passing standard, the computer will continue to give you test items until you’ve received the maximum number: 265 for RN candidates, 205 for PN candidates. After reaching the maximum, the computer bypasses the 95% Confidence Rule and makes a different calculation:
   1. If your final ability estimate is above the passing standard, you will pass.
   2. If your final ability estimate is below the passing standard, you will fail.
3. Run-out-of-time Rule: Called the “R.O.O.T. Rule,” if you haven’t answered the maximum number of test items during the allotted time (six hours for RN candidates, five hours for PN candidates) then the computer does one of two things:
   1. If you haven’t answered the minimum number of items, you will fail.
   2. If you have answered at least the minimum, the computer reviews your last 60 ability estimates. If they were all above the passing standing, you will pass.
   3. If you have answered at least the minimum, the computer reviews your last 60 ability estimates. If your ability dropped below the passing standard, even once, you will fail.

Good news for those who study!

This is a lot of information, we know. We’re not trying to scare you. Rather, we’re showing you that NCLEX is the result of robust, scientific effort. There are no hidden rules or secret strategies. It’s a straightforward method to ensure that new nurses are able to provide safe care for all clients.

Everything you need to prepare for is listed by NSCBN in the test plans. There’s no way to know exactly which medications or procedures will be on your exam; that’s why practice tests offer the best way to learn as much as possible.

First-time passing rates are high for RN and PN candidates who study! With adequate preparation, you can join their ranks. Here are the 2019 statistics:

NCLEX-RN First-Time Passing Rates, US Educated (Number of candidates in parentheses)

• Baccalaureate Degree: 91.22% (84,298)
• Associate Degree: 85.17% (84,794)
• Diploma: 87.89% (2,247)

NCLEX-PN First Time Passing Rates, US Educated (Number of candidates in parentheses)

• 85.63% (48,234)

Are you ready to start the last leg of your journey to becoming a licensed nurse? Nurse Plus is proud to be your study partner. We’re constantly adding new test items and updating previous questions. We know you’ve worked hard to get here and we’re eager to help you make the leap from Graduate to Nurse. We’re grateful that you’ve chosen this satisfying career and wish you success!

About the Author

Winona Suzanne Ball

Nursing Adviser, RN | MHS, Governors State University, IL
Full member of the American Nurses Association. Learn more