NCLEX Study Guide

• Overview of the NCLEX Examination
• NCLEX-RN vs NCLEX-PN
• NCLEX Test Subjects
• NCLEX Pre-Exam Checklist
• NCLEX Study Tips
• Next Step After Passing
• Frequently Asked Questions (FAQs)

Passing the NCLEX is the final step on your journey to becoming a licensed nurse. If you want to prepare for your NCLEX, but aren’t sure how to get started, Nurse Plus has put together a comprehensive NCLEX study guide. With our guide, you’ll find everything you need to create a plan to pass the NCLEX on your first try. Ready? Then let’s get started!

Overview of the NCLEX Examination

The NCLEX (National Council Licensure Examination) is a national standardized test that graduates of accredited nursing programs take to become licensed in the United States or Canada. The examination is designed to determine whether a candidate has gained the competence necessary to provide safe client care as a new Registered Nurse or a Licensed Practical/Vocational Nurse.

Licensure assures the public that minimum qualifications and competencies have been met. It also assists a state’s Nursing Regulatory Board in determining a candidate’s capabilities for performing entry-level RN positions.

Licensure also benefits nurses as it provides clear legal authorization to practice under the state’s defined scope of practice. This also means the titles under which nurses practice, such as registered nurse (RN), licensed practical nurse (LPN), licensed vocational nurse (LVN) and Nurse Practitioner (NP), can only be used by licensed practitioners.

NCLEX and your State Board of Nursing

To obtain a nursing license, you will need to submit proof to your state board of nursing:

• Graduation from an accredited RN or LPN/LVN nursing program
• Successful completion of the NCLEX-RN or NCLEX-PN exam
• A criminal background check (some states)

The NCLEX is designed and administered by the National Council of State Boards of Nursing (NCSBN), an independent organization with members from all 50 states, District of Columbia, and U.S. territories. NCSBN is a separate entity from the American Nurses Association (ANA) Council on State Boards of Nursing, which represents professional nurses.

Every three years, NCSBN performs a robust analysis of the NCLEX, to determine if it includes current nursing practice and matches the standards for safe entry-level practitioners. Categories and questions are adapted or added, based on what nurses report as part of their responsibilities. For example, the current (2019-2022) NCLEX-RN includes more questions on loss and grief, in response to the most recent analysis.

The current NCLEX-RN is in place April 1, 2019-March 31, 2022. To see the RN test plan, click here. The RN test plan is also available in French.

The current NCLEX-PN is in place April 1, 2020-March 31, 2023. To see the PN test plan, click here.

Exam Format and Types of Questions

The NCLEX is 80-90% standard multiple choice questions, with a stem and four options. One of the options is always the best choice. There are also alternate question formats including: Multiple-Response (also called Select-all-that-apply, or SATA), Hot-Spot, Fill-in-the-Blank, Chart or Exhibit, Drag-and-Drop, Graphics, and Audio/Visual Clips. No matter what type of question you answer, it is always pass/fail. No partial credit is given for any question.

The number of questions per exam, including 15 questions that are being analyzed for future exams, are below. You won’t know which ones they are, and won’t be scored on them:

NCLEX RN: Minimum of 75 questions and a maximum of 256

NCLEX-PN: Minimum of 85 questions and a maximum of 205

The number of questions is different for every candidate, because NCLEX uses Computer Adaptive Testing (CAT), which adjusts both the number of questions and their difficulty for each candidate.

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.

Time Length of the NCLEX Exam

Plan to arrive to the testing site about 30 minutes early to check in, show appropriate identification, and store all devices. The testing center will give a brief overview and answer any questions.

You’ll have plenty of time to take your NCLEX, so there is no hurry to finish. RN candidates have up to six hours. PN candidates have up to five hours. The times include a short tutorial and two optional breaks. The first break is about two hours after you begin the exam; the second break is offered after 3.5 hours of testing. The average time candidates spend on the test is about two hours. But you should take the time you need. Once you submit a question, you cannot return to it.

How long your exam will last depends on how many questions CAT delivers, up to the maximum for both RN and PN candidates. Although some questions require making calculations, plan on 60-90 seconds per question. You’ll get good practice at timing with the Nurse Plus tests.

How Your NCLEX Is Scored

The NCLEX exam is a pass/fail exam. Candidates pass the exam when the computer has determined that the competence level is higher than the passing standard. There are three scenarios in which a candidate will pass the exam:

1. The minimum number of questions have been answered and the candidate achieves a competence level significantly above the passing standard.
2. The maximum number of questions have been answered and the candidate achieves a competence level that is above the passing standard, even if not significantly above.
3. The minimum number of questions have been answered but the candidate runs out of time and the last 60 questions have been above the passing standard.

Alternately a candidate will not pass the NCLEX exam in these three scenarios:

1. The minimum number of questions have been answered and the candidate achieves a competence level below the passing standard.
2. The maximum number of questions have been answered and the candidate achieves a competence level below the passing standard.
3. The minimum number of questions have been answered but the candidate runs out of time and falls below the passing standard at any point during the last 60 questions.
4. The minimum number of questions have not been answered in time allowed.

The official results of the exam will be sent directly to the candidate’s state Board of Nursing or Nursing Regulatory Body in approximately six weeks. If your state participates in the Quick Results Service, which allows candidates to access their unofficial results 48 hours after the exam, you can obtain your results for a fee. Currently, the fee is less than $10.

Candidates that fail the exam will receive a two-page Candidate Performance Report (CPR) that outlines how close a candidate came to passing the exam. Candidates that pass will not receive any information regarding their tests. The reason for this is that the feedback could be misused by candidates or employers in making employment decisions.

Difference Between the NCLEX-RN and NCLEX-PN

Although RN and PN candidates cover some of the same content during their programs, there will be differences on each respective NCLEX. As professional nurses, an RN and PN have different scopes of practice, so test items on the examination will have some differences. Nurse Plus provides practice tests and articles for both RN and PN candidates.

The actual testing procedure is the same for a RN and PN candidate; only the number of questions and time limits differ.

Background Education & Experience for NCLEX

NCLEX-RN and NCLEX-PN both include questions based on your education subjects and clinical experience:

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

RN candidates will also be tested on information and concepts from:

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

Distribution of NCLEX Content

NCLEX is based on four categories of Client Needs:

#1 Safe and Effective Care Environment

#2 Health Promotion and Maintenance

#3 Psychological Integrity

#4 Physiological Integrity

The percentage of content for the RN or PN candidate is weighted to cover each of the Client Needs, according to scope of practice and typical daily responsibilities of a professional nurse. By focusing on Client Needs, NCSBN can test for nursing competencies and actions in all client settings and situations.

NCLEX Four Categories of Client Needs Content

Safe and Effective Care Environment

According to NCSBN, a Safe and Effective Care Environment occurs when: “The nurse promotes achievement of client outcomes by providing and directing nursing care that enhances the care delivery setting in order to protect clients and health care personnel.” (2019, p.8)

Health Promotion and Maintenance

To successfully meet the Client Need of Health Promotion and Maintenance, “The nurse provides and directs nursing care of the client that incorporates the knowledge of expected growth and development principles, prevention and/or early detection of health problems, and strategies to achieve optimal health” (NCBSN, 2019, p. 17)

Psychosocial Integrity

Psychosocial Integrity: “The nurse provides and directs nursing care that promotes and supports the emotional, mental and social well-being of the client experiencing stressful events, as well as clients with acute or chronic mental illness” (NCSBN, 2019, p. 21)

Physiological Integrity

NCSBN states, “The nurse promotes physical health and wellness by providing care and comfort, reducing client risk potential and managing health alterations. “ (2019, p. 26)

NCLEX Pre-Exam Checklist

Preparing for the NCLEX exam is an exciting time. You are one step away from beginning your career as an entry-level nurse. We’ve provided a pre-exam checklist with the tasks you’ll need to do before taking the NCLEX exam:

1. 1

   Six Weeks before Graduation: Apply for the NCLEX

   About six weeks before you graduate from nursing school, you’ll receive an application from your nursing school. You will complete the forms and pay the licensure fee to your nursing school. You’ll want to read the NCSBN Candidate Bulletin before registering.

2. 2

   Register for the Exam and Pay Associated Fees

   The second step is to register for the NCLEX with Pearson VUE, the company that administers the test. You can register online or by telephone. Once you have started the process, it will stay open for 365 days, pending a candidate eligibility check from your state’s Nursing Regulatory Board.

1. 3

   Find a Testing Center and Schedule Your Exam

   After applying for licensure with your state’s Nursing Regulatory Board and registering for the NCLEX with Pearson VUE, you will receive an email with an authorization to test (ATT) from Pearson VUE. You must test within the validity dates on the ATT email.

   At this point you will now be eligible to schedule an appointment to test with Pearson VUE by visiting pearsonvue.com or by calling Pearson VUE directly: English: 866-49-NCLEX / 866-496-2539 or Canadian French: 866-288-8454 / 952-905-7407.

   The NCLEX is offered both in the U.S. and at international locations. Find out more about testing centers here.

NCLEX Study Tips

Nurse Plus wants to help you be well-prepared to sit for your NCLEX. We’ll share some tips here and give you some other resources to match your learning style.

Some general hints for everyone:

Don’t cram! No matter how you design your study plan, don’t wait until a week before your scheduled NCLEX to begin. Research shows that cramming decreases your ability to concentrate and retain information. It’s also stressful and contributes to testing anxiety. Students who cram sacrifice sleep, which alters the brain and leads to failure

Space out your study sessions. Dr. Robert A. Bjork, distinguished research professor of psychology at UCLA, points out research that indicates if you study something only twice, you will remember it better. First mentioned in 1850, called the “spacing effect,” studying and waiting between sessions leads to long-term memory. The spacing effect works for words, images, and skills. It works for all ages and cuts across all disciplines. It’s one of the reasons flashcards work so well.

Use mnemonics. A mnemonic is a memory device to help retain and recall information. It’s typically a short phrase or acronym to help you remember something. An example is a way to recall which vitamins are fat-soluble: “All Dogs Eat Kibble.” The fat-soluble vitamins are A, D, E, and K. You’ll find some images of nursing mnemonics here.

Get plenty of sleep. Active study techniques and repeatedly reviewing material strengthens memory and recall. Sleep is also vital for memory; it helps the brain consolidate and store what we’ve learned during the day. You’ll certainly want to be well-rested the day of your exam, but quality sleep is important now, too.

Don’t let past experience influence your answers. During your clinical rotations, you had a chance to put new skills into practice. If you came to nursing school with some healthcare experience, as a CNA, LPN, or tech, you’ve seen that learning doesn’t always match the day-to-day reality. Or perhaps your previous jobs did procedures in a different, but just-as-safe way. Do NOT use your past to answer the questions on the NCLEX. There is no room for “But that’s not how we did it…” You must answer the questions as if you were practicing in a “perfect world.”

How to Structure Your Study

• Set a schedule. Decide which days of the week and what times you want to study for your NCLEX. Commit to them, just as if they were classes at school, and begin as soon as possible. If you can, start 6-8 weeks before your test appointment. Everyone has a different capacity for how long they can study, but experts say 2-4 hours a day is optimal.
• Practice, practice, practice. Use a comprehensive study tool to review NCLEX questions. Nurse Plus Premium has multiple practice tests that shuffle the order of questions and the responses each time you take them. The tests are offered in several ways: by category, by type of question, full tests, and a simulation of the NCLEX.
• Be grateful for mistakes. No one gets every question correct. Use these to help you focus on areas that need more study. Keep a list of test items you miss: Are there common topics? Is there one Client Need category that needs more attention? Do SATA questions trip you up? Think of these as opportunities to improve.
• Use active study techniques. Active study means doing more than just reading and highlighting pages in a book. Depending on your learning style, you might rewrite notes or topics in your own words; make sketches or graphs; be a teacher and explain the content; listen to music while you study; or try a different setting.
• Start a study group. If other students are willing and able, working together can be beneficial. You can quiz each other, ask for explanations, present lessons, create hints and tips for remembering facts, and keep each other accountable. Getting together just once a week, in person or using a conference call platform, helps everyone.
• Find every resource. You have access to unlimited sources of information. Use Nurse Plus, your nursing textbooks, and class notes. Download the RN or PN Test Plan from NCSBN to see the list of questions that may be on your exam. For different explanations of topics, use reliable sources: CDC, PubMed, MedlinePlus (U.S. National Library of Medicine), and Johns Hopkins are good places to start. Consumer articles from Mayo Clinic or organizations such as the American Heart Association can provide easy-to-understand information. NCLEX review books from textbook publishers (Lippincott, Saunders, etc.) are available from booksellers or Amazon.com. YouTube has short lectures and demonstrations.

What to Do on Your NCLEX Test Day

You’ve studied and feel confident about your ability to read the test items, analyze what’s being asked, and choosing the best response(s). Now, all that’s standing between you and your nursing license is the actual NCLEX.

Here are few tips for the big day:

• Schedule your test for your “best time of day.” If you’re a morning person, go as soon as the testing center opens. If you prefer to sleep late, schedule an afternoon time.
• Preparation starts the night before. You already know to avoid last-minute cramming. Eat a nutritious dinner, go to bed early, and get plenty of solid sleep. Set a reliable alarm. Even if you’re nervous when you get up in the morning, eat a good breakfast.
• Know the NCLEX candidate testing rules. It’s important to know what to expect—and what can prevent you from taking the examination.
• Dress comfortably in layers, so you can adjust to the testing center’s temperature. Except for religious or cultural reasons, you’ll be required to leave hats, coats, scarves, and gloves outside the testing room.
• Arrive 30 minutes before the exam. If you are more than 30 minutes late you might have to forfeit the exam and re-register for the exam (including fees).
• Bring your picture ID. This must match the information that you provided during the registration process. You will also provide the following biometrics: your signature, photograph, and palm vein scan.
• Consider bringing water and a snack. The test can be as long as 5-6 hours. It’s a good idea to bring water and your favorite snack to refuel during a break. Food, drink, gum, or candy are not allowed in the testing room, but you can access them during a break.
• When the NCLEX has finished, you will take a short survey. Then you can raise your hand and the test administrator will dismiss you. Your score will not be available or released at the testing center.

What happens after the NCLEX

First of all, relax! You did your best and now you can enjoy more free time with friends and family. If your Nursing Regulatory Board participates in Quick Results Service, you can obtain your “unofficial” results in two business days. The cost is less than $10; get more information on the Pearson VUE NCLEX Candidate website.

Official results will be available from your Nursing Regulatory Board in about six weeks. NCSBN has a useful document, You’ve completed the NCLEX but you still have questions, to give further information about the NCLEX test day and what to expect when your results arrive.

How to Retake the NCLEX If You Don’t Pass

If you didn’t pass the NCLEX, you’ll receive a Candidate Performance Report (CPR) that which shows the areas of relative strength and weakness in the content areas, based on the NCLEX-RN Test Plan or NCLEX-PN Test Plan. This report will prepare you for your next examination.

NCSBN has a retake policy which allows you to retake the exam 45 days after your last NCLEX. Most Nursing Regulatory Boards allow you to take the exam as many as eight times in a year, with a gap of 45 days between examinations. Some jurisdictions limit the number of exam attempts per year so it’s best to check with the Nursing Regulatory Board in your state.

Here are the steps you’ll need to take to retake the NCLEX:

• Contact your Nursing Regulatory Board to obtain the necessary forms and information for re-registration at any time.
• The time between examinations is determined by each Nursing Regulatory Board and NCSBN. Per NCSBN policy, you’ll need to wait a minimum of 45 days between each exam.
• Register for the exam with Pearson VUE and pay the associated fees. You’ll receive a new Authorization to Test (ATT) that will be valid when enough time has passed between examinations.
• Schedule your exam with Pearson VUE

Frequently Asked Questions (FAQs)

What is the best study guide for NCLEX RN?

The best study guide for the NCLEX-RN is Nurse Plus Premium. This program offers a comprehensive range of study materials including over 1,000 practice questions, a NCLEX exam simulator, flashcards, PDF cheat sheets and a personal Challenge Bank. Nurse Plus has is used by some of America’s top nursing schools and is a member of the National League for Nursing. We also offer a “Guaranteed to Pass” money-back guarantee.

How do I study for NCLEX content?

The best way to study for NCLEX content is to take a structured approach. See our tips on creating your own structure above in the “How to Structure Your Study” section. Set aside time each day to review the material, test yourself as you go, and check the information you still need to work on. This can be done using exam prep books or with a comprehensive online review program like Nurse Plus Premium.

When should I study for NCLEX?

You should begin to study for the NCLEX as soon as possible. Graduation means finals and celebrations; once those are over, it’s time to settle in to a study pattern. Many candidates take their NCLEX as soon as possible, about 45 days after graduation. But when you decide to sit for the exam depends on how prepared you are. It’s expensive to retake the NCLEX, so take enough time to study.

Is NCLEX hard to pass?

The NCLEX is challenging. It’s meant to be, in order to ensure that candidates have sufficient knowledge to provide safe client care. Candidates who are prepared and have put in the time to study have an excellent chance of passing. The NCLEX-RN has a first-time pass rate of 88.18% while the NCLEX-PN has a first-time pass rate of 85.63%.

How can I learn more about the actual NCLEX exam?

NCSBN has a FAQ page about what the exam looks like; how the content is distributed in the exam; terminology and key words; cognitive levels, and other useful information. Nurse Plus practice questions and tests are designed and written to help you become familiar with the NCLEX format.

Final Thoughts

You’re ready to start your career as a professional nurse. It’s an exciting time to start your career. You have more options and opportunities than past generations. Being a nurse is demanding yet rewarding. Every year, nurses top the Gallup Poll’s list of “most trusted profession.” People rank the honesty and ethical standards of nurses higher than medical doctors and pharmacists. Being a nurse makes you a member of a proud legacy. We wish you satisfaction and success!