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Information

Since 1994, the licensure examination for registered nurses has been administered year-round by computer, in an adaptive format: NCLEX-RN®. Frequently, candidates for the examination have many questions about the structure and format of the test itself and the rules and regulations concerning the examination procedure.

As an aid to reducing apprehension and time spent on speculation, this section is intended to provide information that candidates need, in outline form; the last segment offers a "question-and-answer" format for specific questions frequently asked by nursing students.

This information was verified as correct at the time that it was compiled from information provided by the National Council of State Boards of Nursing, Inc. (NCSBN), and other parties involved in the testing. If you have further questions, contact the board of nursing in your state.

  1. WHAT NCLEX® IS
    1. National Council Licensure Examination, developed and administered by the National Council of State Boards of Nursing, Inc., with services provided by VUE (Virtual University Enterprises), an NCS (National Computer Systems) Pearson Company.
    2. Tests for minimum nursing competence according to a national standard.
    3. Pass/fail result; must pass to be issued license from state board of registered nursing.
    4. National examination. Application procedure and licensing requirements are determined by each state board and may differ from state to state.
  2. CAT: HOW IT WORKS
    1. Stands for "computer adaptive testing."
    2. "Adaptive" because the computer estimates the candidate's ability after each question; the next question is chosen based on the candidate's estimated ability so far. The test is therefore "adapted" to each candidate; everyone takes a different, "customized" test.
    3. Estimated ability is recalculated after each question until it is precise enough to determine whether the candidate is above or below minimum competence level, in all areas of the test plan. The test will stop as soon as this is determined.
    4. Example: The first question is at a fairly easy level. The candidate answers correctly, so the computer estimates that the candidate's ability level is above the level of this question and selects a harder question; or if the candidate answers incorrectly, it selects an easier question, to pinpoint where the candidate's ability level lies, in each area of the test plan.
    5. After consideration of all available information, the NCSBN determined that safe and effective entry-level RN practice requires a greater level of knowledge, skills, and abilities than was required in 2007 (the date that the NCLEX® was last reviewed/revised). The passing standard was increased in response to changes in U.S. health-care delivery and nursing practice that have resulted in more acutely ill clients being seen by entry-level RNs. An expert panel of nine nurses was convened and performed criterion-referenced standard-setting procedures. The panel's findings supported the creation of a higher passing standard. In addition, the NCSBN considered the results of national surveys of nursing professionals including nursing educators, directors of nursing in acute care settings, and administrators of long-term care facilities. The NCSBN voted on December 10, 2009, to raise the passing standard for the NCLEX® examination. The new passing standard is –0.16 logits on the NCLEX® logistic scale, 0.05 logits higher than the previous standard of –0.21 logits. Logits are usually a foreign concept to the general public. "Logit" is an abbreviation for "log odds unit." Basically, logits are a useful unit of probability. Using the candidate responses, the difficulty of the items relative to each other (not relative to the candidates) is assessed. Once the hierarchy of difficulty for items is established, then the ability of a candidate can be described as the point on this item hierarchy, or continuum, where the candidate has a 50-50 chance of correctly answering an item. When a candidate encounters an item that is lower than his or her ability, then he or she will have a greater than 50-50 chance of answering the item correctly. Conversely, when a candidate encounters an item that is higher than his or her ability, then he or she will have a less than 50-50 chance of answering the question correctly. The deviation from 50-50 is governed by the size of the difference between the person's ability and the item's difficulty. A candidate's ability could be described by illustrating the type of item that he or she finds challenging. The latest passing standard took effect on April 1, 2010, in conjunction with the 2010 NCLEX® Test Plan (see Section V).
  3. SOME SPECIFICS
    1. Format
      1. Most questions will be multiple choice, each with four options from which you choose only one option. In addition to multiple-choice items, candidates may be administered items written in alternate formats (Table 1.1. Description of NCLEX[®] Question Formats).The formats may include but are not limited to multiple response (including ordered response), fill-in-the-blank, numerical entry, drag and drop, and/or hot spots. All item types may include multimedia such as charts, tables, graphics, sound, and video.
      2. One question at a time appears on screen (Figure. 1.1. Sample Appearance of NCLEX-RN[®] Question on Computer Screen).
      3. Each question stands alone (no "scenarios" with several spin-off questions); no question will relate to information given in previous questions.
    2. Answering
      1. As candidate chooses the answer to each question, he or she will be asked to confirm that answer by pressing the <NEXT> button, or can change that answer before confirming.
      2. Must answer every question (no penalty for guessing; will simply count as a correct or incorrect answer and adjust difficulty of next question accordingly).
      3. Cannot go back to previous questions either to review or change answers (because the level of subsequent questions administered is based on previous answers).
    3. Number of questions
      1. 75 to 265, including about 15 "tryout" questions that are not scored (these are questions being field tested for use on future examinations).
      2. Depends on number needed to determine whether candidate is definitely above or definitely below minimum competence level.
      3. Taking only the minimum can mean either pass or fail; it indicates that it took fewer questions to determine whether this candidate is above or below minimum competence, but does not indicate which!
    4. Timing
      1. No time limit for each question.
      2. Maximum time for test is 6 hours.
      3. A preprogrammed optional break is given after 2 hours; a second preprogrammed optional break may be taken after another 1½ hours.
    5. The test will stop when any one of the following occurs:
      1. A "pass" or "fail" determination can be made.
      2. The maximum number of questions has been taken (265).
      3. The test has lasted for 6 hours, including examination instructions, sample items, and all rest breaks.
    6. The computer
      1. Computer experience will not be necessary.
      2. A mouse is used to move down the list of options and select and confirm answer choice by pressing the <NEXT> button; all keys will be "turned off."
      3. An on-screen calculator will be available.
      4. Candidate receives a brief orientation in the use of the mouse and on-screen calculator with sample questions before beginning the examination.
  4. ADMINISTRATION
    1. Application and scheduling
      1. Involves three parties: the state board of nursing, VUE, and Pearson Professional Test Center.
      2. Candidate applies to the board of nursing in the state in which licensing is desired; must meet requirements of that state board. (There is a test fee, and some state boards may also require an administrative fee.)
      3. After state board determines eligibility and fees are received, candidate will be mailed an Authorization to Test (ATT) and information on available Pearson Professional Test Centers, which serve as testing sites (at least one per state; some states have many more).
      4. Candidate must schedule an appointment to take the examination by calling NCLEX® Candidate Services or going to the NCLEX® Candidate Web site. (Note: These procedures differ in some states, such as Massachusetts. Candidates should follow instructions from state board.)
      5. Candidate contacts Pearson Professional Test Center (or other designated test site) to set up testing appointment (5 days/wk, 15 hr/day, in 6-hr time slots). Candidates may test at any test center in any state (they do not have to take the test in the same state to which they have applied for licensure).
      6. After testing, results are communicated to state board to which the candidate applied, which mails results to candidate (time frame will differ by state). Candidates who do not pass will receive a Candidate Performance Report, indicating performance in each area of the test plan relative to the passing standard, and information about retesting.
    2. Test environment: Pearson Professional Test Center test sites
      1. Up to 30 workstations, each with computer terminal, desk lamp, work surface, and scratch paper.
      2. Designed for security, monitored by a proctor and by videotape.
      3. Candidate must present Authorization to Test and two signed pieces of identification, one with picture; candidate must sign in and be fingerprinted and photographed.
      4. Lockers or other secured storage provided; personal items restricted in testing room.
  5. TEST PLAN, DEVELOPMENT
    1. Test plan
      1. Bloom's taxonomy for the cognitive domain is used as a basis for writing and coding items for the examination. Since the practice of nursing requires application of knowledge, skills, and abilities, the majority of items are written at the application or higher levels of cognitive ability, which requires more complex thought processing.
      2. Client needs are the bases, or "dimensions," for the test plan (Table 1.2. Examination Weight Given to Each Category of Health Needs of Clients Based on Current Practice Analysis Study).
      3. Health needs of clients: The test plan primarily emphasizes meeting the clients' physical needs in actual or potentially life-threatening, chronic, or recurring physiological conditions and the needs of clients who are at risk for complications or untoward effects of treatment. Subneeds include (1) basic care and comfort (6%–12%), (2) pharmacological and parenteral therapies (13%–19%), (3) reduction of risk potential (10%–16%), and (4) physiological adaptation (11%–17%).
        The second highest category of emphasis is safe, effective care environment, which focuses on (1) management of care (16%–22%) and (2) safety and infection control (8%–14%). Health promotion and maintenance (6%–12%) covers growth and development throughout the life span and prevention and early detection of disease. Psychosocial integrity (6%–12%) concerns coping and adaptation in stress- and crisis-related situations throughout the life cycle.
      4. Nursing process (nursing behaviors): The examination integrates steps of the nursing process, as applied to client situations from all stages in the life cycle and to common health problems in all the major health areas and based on current morbidity studies. It is a problem-solving approach to client care that includes data collection (assessment, analysis), planning, implementation, and evaluation.
      5. Levels of cognitive ability: Most items are at the levels of application (application of rules, procedures, principles, ideas, and theories, and using a concept in a new situation) and analysis (analysis of data to set priorities and see relationships). Some items include knowledge and comprehension (simple recognition or recall of material; restating or reorganizing material to show understanding).
      6. Categories of nursing knowledge and other concepts that are commonly tested:
        1. Caring ways by which nursing can assist individuals to maintain health and cope with health problems. It involves interaction between nurse and client in a collaborative environment, with mutual respect and trust. The nurse provides hope, support, and compassion to achieve desired outcomes. (See nursing care plan/implementation sections in each unit.)
        2. Communication (see Chapter 10. Psychosocial Integrity).
        3. Effects of age, sex, culture, ethnicity, and religion on health needs (sociocultural components) are integrated into all units; for special emphasis see Chapter 3. Safe, Effective Care Environmentand Chapter 9. Physiological Integrity: Basic Care and Comfort—Nutrition (dietary implications).
        4. Documentation; legal and ethical aspects of nursing, accountability (see Chapter 3. Safe, Effective Care Environment).
        5. Self-care.
        6. Teaching-learning; helping client and significant others to acquire knowledge, skills, and attitudes that facilitate changes in behavior. (See health teaching sections [after the conditions] that are part of Nursing care plan/implementation.)
        7. Nursing fundamentals (see Chapter 11. Reduction of Risk Potential).
        8. Nutrition and diet therapy (see Chapter 9. Physiological Integrity: Basic Care and Comfort—Nutrition).
        9. Pharmacology (see Chapter 8. Physiological Integrity).
        10. Communicable diseases (see Chapter 5. Health Promotion and Maintenance and Chapter 6. Physiological Integrity).
        11. Natural and behavioral sciences (integrated into all units).
        12. Normal growth and development (see Chapter 4. Health Promotion and Maintenance, Chapter 5. Health Promotion and Maintenance, and Chapter 10. Psychosocial Integrity).
        13. Basic human needs (see Chapter 10. Psychosocial Integrity).
        14. Individual coping mechanisms (see Chapter 10. Psychosocial Integrity).
        15. Actual or potential health problems (see Chapter 4. Health Promotion and Maintenance, Chapter 5. Health Promotion and Maintenance, Chapter 6. Physiological Integrity, and Chapter 7. Physiological Integrity).
        16. Life cycle.
        17. Client environment (there is continual reference throughout this resource related to protection from harm against airborne irritants, cold, and heat; identification of environmental discomforts such as noise, odors, dust, and poor ventilation; elimination of potential safety hazards; maintenance of environmental order; and cleanliness).
    2. Development
      1. The Examination Committee of the National Council prepares the test plan, which is approved by the delegates representing the state boards of nursing. It is designed to reflect the knowledge and skills needed for minimum competence by a newly licensed nurse to be a safe and effective practitioner in entry-level nursing, as determined by studies of nursing practice (performed every 3 years to reflect current nursing practice).
      2. State boards take turns nominating item writers (faculty, clinical nurse specialists, or beginning practitioners); the Board of Directors of the National Council then selects from this group those who meet the criteria for item writing based on expertise in a particular area of nursing, type of nursing program, credentials, regional balance, etc. The item writers write questions based on common clinical situations and according to the test plan. Then the questions are researched and reviewed by a panel of experts (nominated by the state boards), by those state boards that choose to review, and by the National Council's Examination Committee.
      3. Finally, the questions are field tested to eliminate questions that may be ambiguous, irrelevant, or not equally applicable to all regions of the United States. (Each candidate taking the NCLEX® will take 15 of these "tryout" questions, mixed in with the regular questions; they will not count toward that candidate's performance.) The data gained through field testing are also used to analyze and determine the difficulty level of a question.
    3. Passing standard: The passing standard is criterion referenced; this means that there is no fixed percentage of candidates who pass or fail. Passing depends solely on performance in relation to the level of minimum competence. The passing standard is reviewed every 3 years.
  6. FREQUENTLY ASKED QUESTIONS AND ANSWERS ABOUT NCLEX-RN®
    1. Test questions, test plan
      1. How many questions will there be? You will take anywhere from 75 to 265 questions.
      2. Where do the questions come from? The state boards of nursing nominate item writers, who must meet various criteria (see V. B. Development, The Mechanics of the National Council Licensure Examination for Registered Nurses-Computer Adaptive Test (NCLEX-RN[®])).
      3. Will there be questions involving conditions with which I may not have had experience in my nursing program? Most of the questions are about clients with conditions familiar to you and are representative of common health problems on a national basis. Some questions may relate to nursing problems with which you may not have had prior experience; their purpose is to test your ability to apply knowledge of specific principles from the physical, biological, and social sciences to new situations.
      4. Can some questions have more than one answer? Yes. In some questions, only one of the four options is the best answer. In alternate items, you may be asked to choose more than one option as your answer.
      5. Will I get partial credit for selecting the next-to-the-best answer? No. Your answer will be treated only as correct or incorrect.
      6. If everyone takes a different test, how can it be fair? Each candidate is tested according to the same test plan, and the same passing standard. It may simply require more items to reach a stable pass/fail determination for one candidate, while another may require fewer questions to demonstrate competence level.
      7. Do diploma, associate, and baccalaureate graduates all take the same test? What about graduates from schools outside the United States? All candidates are held to the same test plan and passing standard, and take the "same test." (Of course, due to the nature of CAT, each will receive an "individualized" test, without regard to degree, or to state or country of education.)
      8. Does the examination differ by state? The examination is a national examination; all candidates are held to the same test plan and passing standard, and take questions from the same pool. (Again, through CAT, each candidate receives an "individualized" test, but without regard to state.)
    2. Taking the test/after the test
      1. Can I skip questions? No. You must answer each question in order to move on to the next. You also will not be able to return to previous questions to try them again or change the answer (because the level of subsequent questions administered is based on previous answers).
      2. What if I just don't know the answer? Use the tips in TEST-TAKING-TIPs and Guidelines: Sixty Strategies to Use in Answering Questions, Chapter 2. Guidelines and Tips for International Nurses and Repeat Test-Takers, Test-Taking-Tips and Guidelines: Sixty Strategies to Use in Answering Question, to make your best guess. You will need to answer the question in order to move on to the next question.
      3. When will I know my results? Will the computer tell me? You will not learn your pass/fail status at the testing center; the results will be communicated directly to your state board of nursing, who will mail the results to you. The time frame may differ from state to state, but most candidates should receive their results within 10 days to 2 weeks after taking the examination. Some states provide a Results-by-Phone Service, where unofficial results are available 3 business days after taking the examination. There is a flat fee for this service. Note: Taking only the minimum number of questions, or taking the maximum, is not an indication of whether you have passed or failed. It merely indicates that a lesser, or greater, number of items was required to reach a determination.
      4. What percentage must I answer correctly to pass? Because of the nature of CAT, a percentage rate is not used to determine passing or failure. The test determines whether you are above or below standard competence by determining not the number of questions you answer correctly, but rather the difficulty level you can consistently answer correctly. The process of administering harder or easier questions, as described in II. CAT: HOW IT WORKS, The Mechanics of the National Council Licensure Examination for Registered Nurses-Computer Adaptive Test (NCLEX-RN[®]), continues until you reach the level where you answer approximately 50% of the complex questions correctly. Note: When practicing with questions of mixed difficulty, such as those in this resource, you may wish to use 80% correct as a "benchmark" goal for yourself.
      5. If I do not pass, can I retest only those areas of the test plan in which I tested poorly? No. The whole examination is on a pass/fail basis.
      6. Can I repeat the examination before I get my results? No.
      7. How many times can the examination be repeated, and when? The National Council allows you to repeat the examination not more than once in any 45-day period; however, each state board may set its own, more restrictive time limits and retake requirements. At present, most states allow the examination to be repeated after 45 days; other states still require a 91-day waiting period before repeating the examination.
      8. Who grants the nursing license? The license is granted by the state board of nursing to which you applied and for which you took the examination.
    3. Testing facilities
      1. Can I bring any materials into the examination room? There are severe restrictions on personal items allowed in the examination room; you will be provided with a locker or other secure place for your belongings. Do not take any study materials (books, notes, calculators, etc.), pens, pencils, candy, chewing gum, drinks, food, watches, pagers, cell phones, note pads or Post-it notes, purses, wallets, or cameras into the examination building.
      2. How many people will take the test at the same time? Up to 30 people may be at computer workstations in your testing room; however, they may not all be taking the NCLEX®, because Pearson Professional Test Centers also offer other services.
      3. When and where will I take the test? As soon as you receive your authorization (ATT), you must contact a Pearson Professional Test Center facility to set up your own testing appointment (5 days/wk, 15 hr/day, in 6-hr time slots). There is at least one facility per state, although most states have many more. A candidate must test within the validity dates of the ATT. These dates cannot be extended. If the ATT expires, you may be required to re-register and repay to test.
      4. What accommodations are available for candidates with disabilities? All test centers are accessible to candidates with disabilities. Other accommodations will be made only with the prior authorization of the board of nursing; contact your state board before submitting your application.