What you must know about the NCLEX BEFORE taking the exam

Introducing the NCLEX: What it is, content breakdown, timing, exam requirements

The end is near for nursing students. The NCLEX is the exam we have all been studying for, the culmination of all our efforts over these last three years (or 15 months for our accelerated student counterparts. You guys are superhuman).

We’ve all kept the NCLEX in the back of our minds as we studied for our regular nursing class exams, but despite knowing that (perhaps) the most important exam of our lives is coming, we still don’t know too much about it.

It’s not only important to study the material for a test, but to also know exactly what to expect and how it is organized so that we don’t panic on exam day.

In this article, we will cover:

1. What is the NCLEX?

2. What types of questions will be on it?

3. NCLEX content breakdown

4. How much time do we get?

5. Exam requirements

What is the NCLEX?

The NCLEX is a standardized exam that is written by the National Council of State Boards of Nursing (NCSBN). It is a computer adaptive test (CAT), meaning the exam will be administered on a computer.

Therefore, test-takers will not be allowed to bring in writing utensils, paper, or a calculator. Everything will be on the computer.

The NCLEX tests your nursing knowledge and your ability to make clinical decisions. It is used to regulate nursing and defines what an entry-level nurse should know.

What the heck is a CAT?

It’s obviously the animal that purrs. We’ll be petting it like an evil boss lady during the exam. Ha...sorry.

Anywho, a CAT is a test whose questions are based on your answer to the previous question. So, if you got the previous question wrong, you will get an easier question. If you got the previous question right, you will get a harder question. This is to make sure you won’t receive questions that are too easy or too hard to answer.

The HESI is also a computer adaptive test. Some nursing students may have taken the HESI, which is a practice exam for the NCLEX. For students who have not, I believe most students have been required by their schools to take some form or other of practice HESI questions, which also uses the CAT program.

What types of questions will be on the NCLEX?

Great question! After taking at least 15 years’ worth of exams, we’re all pretty familiar with the typical multiple-choice questions with four potential answer choices. Those will definitely be on the exam.

But to keep things interesting, they’ve come up with new ways to torture us.

These new torture devices are called Alternate Format questions.

Alternate Format questions include:

1. Select all that apply: these are the bane of any nursing students’ existence. Why? Because to answer these questions, you must know whether each answer choice is true or false depending on what the question is asking. There may be only one answer or there may be multiple answers. That means that we cannot use our favorite method to approach this question: process of elimination.

2. “Hot Spot”: these require you to click on an area of a diagram or table with your computer mouse to answer the question.

3. Drag & Drop: these give you a list of scrambled nursing interventions and require you to place them in the order that you should do them. This means you need to know the required steps to complete the care for the patient and know how to prioritize the interventions. They’re also known as ordered response questions.

4. Fill in the blank: these are the med-math questions! The answers will be numbers. There will be a calculator on your computer to help you complete these sorts of questions. Know your conversions (1 kg = 2.2 lbs. ya’ll!) and be careful with your units.

But that’s not all! Yes, sorry there’s more.

There are also other Alternate Format questions that are also multiple-choice questions. These include:

1. Chart/Exhibit: these questions come with a chart or an exhibit that will help you answer the question.

2. Audio: you will be given an audio clip, then asked to interpret what you have just heard. It’ll likely be heart or lung sounds.

3. Graphic: these will have a picture or a diagram as your multiple-choice options instead of the regular text answer options. An example would be interpreting EKG diagrams.

NCLEX Content Breakdown

Ah, the part everyone’s been waiting for. What in the world is going to be on this exam? I can’t imagine re-studying everything I’ve learned in the past three years!

Well, here’s a breakdown provided to us by the NCSBN themselves in their most recent 2019 NCLEX-RN Test Plan. It can be downloaded if you would like to view it yourself.

The NCLEX-RN is based upon four Client Needs categories. Two Client Needs categories will have subcategories, while two don’t. The four larger Client Needs categories, their smaller subcategories, and their percentage breakdowns on the exam are:

1. Safe & Effective Care Environment

a. Management of Care: 17-23%

b. Safety and Infection Control: 9-15%

2. Health Promotion & Maintenance: 6-12%

3. Psychosocial Integrity: 6-12%

4. Physiological Integrity

a. Basic Care and Comfort: 6-12%

b. Pharmacological and Parenteral Therapies: 12-18%

c. Reduction of Risk Potential: 9-15%

d. Physiological Adaptation: 11-17%

These category names are pretty self-explanatory but extremely vague, so there are further breakdowns into what each category and subcategory specifically include.

If you want a list of the specific content topics related to each category, you can head over to NCSBN’s NCLEX-RN Test Plan (I’ve included a link to their page above) and go straight to their page 8, which has a comprehensive list of what you should be looking for.

I won’t go into each category’s nitty gritty specifics, but I would like to touch upon some broader topics included in each category and list out which nursing classes the topics in the category was generally taught in.

Just a disclaimer, these topics may not exactly correspond to what was taught in each class listed, as I wrote this based off my own experience with nursing classes/nursing school, but it’s the general idea.

Safe & Effective Care Environment

• Management of Care: Intro to Nursing (advocacy, prioritizing, legal rights), Foundation of Ethics & End-of-life Care

• Safety & Infection Control: Fundamentals of Nursing (isolation precautions, injury prevention, safety measures)

Health Promotion & Maintenance

• Gerontology, OB/Newborn Care, Pediatrics (focus on developmental stages), Fundamentals of Nursing (esp. physical assessment techniques for each body system)

Psychosocial Integrity

• Mental Health/Psych, Introduction to Nursing (cultural diversity, stress, therapeutic communication)

Physiological Integrity

• Basic Care & Comfort: Medical-Surgical (non-pharmacological interventions, elimination, assistive devices, rest & sleep), Nutrition

• Pharmacological & Parenteral Therapies: Pharmacology (Adverse effects, contraindications, therapeutic effect, interactions, blood products, med-math, pharmacological pain management), Medical-Surgical (CVADs, TPN)

• Reduction of Risk Potential: Med-Surg (v/s, lab values, diagnostic tests, complications of & education on diagnostic/treatment procedures, venipuncture/central lines, inserting & maintaining tubes & lines, post-op & pre-op teaching)

• d. Physiological Adaptation: Med-Surg (body system alteration, fluid & electrolyte imbalances, medical emergencies, hemodynamics), Pathophysiology (patho of a condition, general pathophysiology principles like immunity)

How much time do we get on the NCLEX?

According to NCSBN’s website, test-takers have a maximum of 5 hours, which includes the beginning tutorial and two optional breaks.

The first break is 2 hours into the test, the second is 3.5 hours into the test.

The minimum amount of questions is 75 and the maximum is 265, but you can get any number of questions in between.

Requirements to take the exam

As we all know, we can’t just waltz into the test room, sit our butts down, and take the exam. We must register, obtain authorization, pay a fee, and schedule the exam before we can even take the NCLEX.

You can view the official steps to take the NCLEX on NCSBN’s website.

To make things simple, I’ve listed out the steps here:

1. Apply to your Nursing Regulatory Body (NRB) to obtain authorization to test (ATT). If you are applying to take the NCLEX and get registered in the US, go to the NYSED website. If you scroll a bit down, there is a section titled “Instructions for Applying for Licensure as a RN” where you can select the correct pathway for you, then follow the steps. There should be an online form for you to submit. There is a registration fee of $143 if this is your first registration. If you are not applying in the US, here is the website for all other NRBs.

2. Register with Pearson VUE.

3. Pay the exam fee ($200 USD).

4. Once you are made eligible and have your ATT, you can schedule your exam.

5. Show up to your exam date! Don’t forget to bring your ID or you will not be allowed to test! You do not need pens, pencils, or paper as everything is on the computer.

Note that after registering to take the NCLEX, you only have 365 days to obtain your authorization to test. If you don’t get your ATT in that time period, you will need to register and pay again.

Good luck to everyone taking the exam!

Sources

NCLEX & Other Exams. NCSBN. https://www.ncsbn.org/nclex

Nursing, K. (2020). Nclex-Rn Prep Plus: 2 Practice Tests + Proven Strategies +

Online + Video. Kaplan Publishing.

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