About the NCLEX-RN

The NCLEX® is designed to test knowledge, skills, and abilities essential to the safe and effective practice of entry level nursing. The NCLEX-RN is a mandatory licensing exam administered on a state or province level in the United States and Canada. It is required for initial recognition as a registered nurse in North America. The NCLEX-RN may be taken only by graduates of a nursing program resulting in either an Associate Degree of Nursing (ADN) or a Bachelor of Science in Nursing (BSN). The registration fee for the NCLEX-RN is currently $200 USD or $360 CAD, with additional fees applicable for state registration or international exams.

Examination Content

The NCLEX-RN focuses on testing comprehension of a fundamental body of knowledge regarding competency levels required for safe, efficient, and effective nursing care at the entry level immediately after graduation. The majority of the test covers risk reduction, recognition of emergent situations, knowledge of the current evidence-based standards of care, and selecting scenario-appropriate nursing actions.

NCLEX-RN includes test items in the following content areas:

  • Management of Care
    • Advance Directives, Advocacy, Assignment, Delegation, and Supervision
    • Case Management, Client Rights, Collaboration with Interdisciplinary Team
    • Concepts of Management, Confidentiality/Information Security
    • Continuity of Care, Establishing Priorities, Ethical Practice
    • Informed Consent, Information Technology, Legal Rights and Responsibilities
    • Performance Improvement (Quality Improvement), Referrals
  • Safety and Infection Control
    • Accident/Error/Injury Prevention, Emergency Response Plan, Ergonomic Principles
    • Handling Hazardous and Infectious Materials, Home Safety
    • Reporting of Incident/Event/Irregular Occurrence/Variance, Safe Use of Equipment
    • Security Plan, Standard Precautions/Transmission-Based Precautions/Surgical Asepsis
    • Use of Restraints/Safety Devices
  • Health Promotion and Maintenance
    • Aging Process, Ante/Intra/Postpartum and Newborn Care, Developmental Stages and Transitions
    • Health Promotion/Disease Prevention, Health Screening, High-Risk Behaviors
    • Lifestyle Choices, Self-Care, Techniques of Physical Assessment
  • Psychosocial Integrity
    • Abuse/Neglect, Behavioral Interventions, Chemical and Other Dependencies/Substance Use Disorder
    • Coping Mechanisms, Crisis Intervention, Cultural Awareness/Cultural Influences on Health
    • End-of-Life Care, Family Dynamics, Grief and Loss, Mental Health Concepts
    • Religious and Spiritual Influences on Health, Sensory/Perceptual Alterations, Stress Management
    • Support Systems, Therapeutic Communication, Therapeutic Environment
  • Basic Care and Comfort
    • Assistive Devices, Elimination, Mobility/Immobility
    • Non-Pharmacological Comfort Interventions, Nutrition and Oral Hydration
    • Personal Hygiene, Rest and Sleep
  • Pharmacological and Parenteral Therapies
    • Adverse Effects/Contraindications/Side Effects/Interactions, Blood and Blood Products
    • Central Venous Access Devices, Dosage Calculation, Expected Actions/Outcomes
    • Medication Administration, Parenteral/Intravenous Therapies, Pharmacological Pain Management
    • Total Parenteral Nutrition
  • Reduction of Risk Potential
    • Changes/Abnormalities in Vital Signs, Diagnostic Tests, Laboratory Values
    • Potential for Alterations in Body Systems, Potential for Complications of Diagnostic Tests/Treatments/Procedures
    • Potential for Complications from Surgical Procedures and Health Alterations, System-Specific Assessments
    • Therapeutic Procedures
  • Physiological Adaptation
    • Alterations in Body Systems, Fluid and Electrolyte Imbalances, Hemodynamics
    • Illness Management, Medical Emergencies, Pathophysiology, Unexpected Response to Therapies

Test Length and Format

The NCLEX-RN is a computer-based adaptive exam that uses an algorithm to ensure that candidates have been tested on all areas of the NCLEX-RN National Council of State Boards of Nursing blueprint to become a registered nurse. All tests contain a minimum of 75 questions, after which the test may end at any point when the algorithm determines the candidate has met, or failed to meet, a statistical degree of certainty regarding clinical competency. If a candidate has borderline performance for the majority of the examination, the test will automatically end at 6 hours or 265 questions, whichever comes first.

Type of Questions

  • Single best response items (radio button)
  • Multiple-response items that require a candidate to select two or more responses (check boxes)
  • Fill-in-the-blank items that require a candidate to type in number(s) in a calculation item (text box)
  • Hot spot items that ask a candidate to identify one or more area (s) on a picture or graphic (image coordinates based)
  • Ordered response items that require a candidate to rank order or move options to provide the correct answer (sorting)
  • Chart/exhibit format in which candidates will be presented with a problem and will need to read the information in the chart/exhibit to answer the problem
  • Audio/video item format with the candidate presented with audio/video clip and headphones to listen/view and select the option that applies
  • Graphic options instead of text for the answer options that require selection of a graphic as an appropriate answer
  • Any item formats, including standard multiple-choice items, may include multimedia, charts, tables, or graphic images

Computer Adaptive Examination (CAT)

The NCLEX® item selection algorithm is designed for maximum efficiency. Items are chosen based on an estimate of the candidate’s ability, so candidates have about a 50% chance of answering each item correctly. Therefore, candidates should not take the NCLEX® with the expectation that they will be able to answer every item correctly. When candidates see an item they do not know, they should consider the item carefully and answer the best they can. The computer will not allow a candidate to proceed to the next item without answering the previous one.

Currently, the NCLEX® uses a 95% confidence interval to make pass/fail decisions. To achieve a confidence interval greater than 95%, the exam would be substantially longer and more costly for candidates. The more precise the estimate (ie, wider confidence interval), the more items that will have to be answered to achieve this result. Weighing the costs and benefits, NCSBN made the policy decision that NCLEX® will be scored using the 95% confidence interval.

As a candidate takes the exam, items are selected based on the candidate's response to previous items. The exam ends when it can be determined that a candidate's performance is either above or below the passing standard, regardless of the number of items answered or the amount of testing time elapsed.

The difficulty of an item is the highest level of thinking that is required on the part of the candidate to answer that item correctly. The cognitive level does not change whether the candidate answers the item correctly or incorrectly.

There is no set p-value (percentage of candidates correctly answering the item) that governs whether an item will be accepted into the item pool. Because the NCLEX® is an adaptive exam, items in different difficulty levels are required to build the item pool for candidates with a wide range of nursing ability.

Exam Facts

  • The NCLEX-RN was first given in 1983 as a paper-based examination, with 80,000 test-takers annually. Nearly 200,000 candidates were expected to take the exam in 2014.
  • All examinations are administered at Pearson VUE testing centers, throughout the United States. Exams may also be taken in Canada, and in January 2015, the exam became available in French. The NCLEX-RN may be scheduled at any Pearson VUE testing center by appointment.
  • Content is reviewed regularly by the NCSBN based on graduate surveys, with recent changes emphasizing the evolving complexity of modern nursing and client care in a variety of clinical scenarios.
  • In 2013, the NCLEX-RN was adjusted to a higher standard of minimal competency, resulting in the overall pass rate dropping to 80%. For the first eight months of the new exam, nearly 22,500 out of 115,000 candidates failed.
  • In 2012, the average number of items (questions) administered per candidate was around 119 on the NCLEX-RN and 117 on the NCLEX-PN.
  • Currently, an average RN exam lasts for 2.5 hours and an average PN exam lasts for 2.3 hours.

Leading reasons for delaying or not taking the NCLEX® Exam

Lack of confidence in ability to pass the examination

Given the amount of study that goes into preparing for the NCLEX® exam, many can get overwhelmed and feel that they are not fully prepared. There are many study materials on the market with differing points of view, leading to uncertainty and a delay in finding the right tools.

  • Our goal at UWorld is to ensure that all our users feel prepared and confident when it is time for their NCLEX® exam. We teach you the critical reasoning skills used by health care professionals, providing NCLEX® exam preparation and honing skills for a career in nursing.
  • With our vast bank of questions, users will be challenged with scenarios that will test a variety of different subjects. Users can also create tests in specific subjects to strengthen areas of weakness.

General test anxiety

Many test takers dread test day. Test taking anxiety can cause anyone to worry about performance, especially for such an important test. A student can study a great deal, but without knowing how the test will look and feel, it can be difficult to feel comfortable when it comes to actually taking the test.

  • We have built a comprehensive layout to mimic the NCLEX® examination and promote a sense of familiarity so users will feel at ease when taking the actual exam.
  • Our scoring statistics will help users pinpoint their areas of weakness.

Not enough time to prepare

Everyone studies and learns differently; one study method of may not work for everyone. When looking for study materials, students may feel pressured to choose the same option as everyone else instead of one that fits their own personal needs.

With a variety of UWorld NCLEX-RN Qbank subscription durations, users may start their preparation at any time, helping all be ready on exam day.

Registration or authority-to-test letter expired

When you have spent months preparing for a test, it can be difficult to know when to take it. Given life stresses and feelings of anxiety and unpreparedness, it can be easy to keep delaying the test date.

The UWorld NCLEX-RN Qbank will not schedule your test date, but will prepare you to select a testing date with confidence.

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