About the NCLEX® Exam​

What you need to know

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In order to become a licensed nurse in the United States or Canada, it is required that candidates pass the NCLEX exam. This makes it one of the most high-stakes professional exams offered in North America. For students preparing to take either the NCLEX-RN® or the NCLEX-PN®, here is some information about the exam:

What is the NCLEX Exam?

The NCLEX (National Council Licensure Examination) is a licensure exam that every state regulatory board uses to test knowledge, skills, and abilities essential to the safe and effective practice of entry-level nursing. The exam is required for initial recognition as a nurse in North America.

There are two different NCLEX exams:

  • NCLEX-PN: This exam is taken by students looking to become licensed as a practical (LPN) or vocational nurse (LVN).
  • NCLEX-RN: This exam is taken by students looking to become licensed as a registered nurse (RN).

Who Takes the NCLEX?

The NCLEX-RN may be taken by graduates of a diploma program for RN licensure or a nursing program resulting in either an Associate Degree of Nursing (ADN) or a Bachelor of Science in Nursing (BSN).

The NCLEX-PN may be taken by those who obtain a diploma in licensed practical nursing or licensed vocational nursing.

Registration Information for the NCLEX:

Before taking the NCLEX, it is required that an individual attain an Authorization to Test (ATT). To gain this authorization, submit an application for licensure/registration to the nursing regulatory body where you wish to be licensed/registered. This is required for eligibility to take the NCLEX.

Candidates can register for their exam date with Pearson Vue, a third party organization that administers the test. Test sites fill up quickly, so students are encouraged to register for their exam well before their ATT is close to expiration (It varies from one nursing regulatory body (NRB) to another, but the average length of an ATT is 90 days.)

Prices are subject to change, but currently the cost of registration for both the NCLEX-RN and NCLEX-PN is $200. Additional fees for licensure are determined by the individual State Boards of Nursing.

Examination Content:

The content for the NCLEX-RN and the NCLEX-PN is similar; however, the NCLEX-RN focuses on the management of care and supervision of others, while assisting RNs and working under supervision is more central to the NCLEX-PN.

For the NCLEX-RN exam, candidates must display competency in these bodies of knowledge:

  • Social Sciences (psychology and sociology)
  • Biological Sciences (anatomy, physiology, biology, and microbiology)
  • Physical Sciences (chemistry and physics)

Throughout the exam, in each category and subcategory, the following critical problem solving concepts are tested:

  • Nursing process
  • Caring
  • Communication and documentation
  • Teaching and learning
  • Culture and spirituality

According to the NCSBN test plan, the distribution of content for the NCLEX-RN exam through March 31, 2022 is as follows:

Safe and Effective Care Environment

  • Advance Directives/Self-Determination/Life Planning
  • 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)
  • Referral
  • 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
  • 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
  • Abuse/Neglect
  • Behavioral Interventions
  • 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
  • Substance Use and Other Disorders and Dependencies
  • Support Systems
  • Therapeutic Communication
  • Therapeutic Environment

Physiological Integrity

  • Assistive Devices
  • Elimination
  • Mobility/Immobility
  • Non-Pharmacological Comfort Interventions
  • Nutrition and Oral Hydration
  • Personal Hygiene
  • Rest and Sleep
  • 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 (TPN)
  • 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
  • Alterations in Body Systems
  • Fluid and Electrolyte Imbalances
  • Hemodynamics
  • Illness Management
  • Medical Emergencies
  • Pathophysiology
  • Unexpected Response to Therapies

The NCLEX-PN tests that the candidate demonstrates knowledge in these two bodies of knowledge:

  • Social Sciences (psychology and sociology)
  • Biological Sciences (anatomy, physiology, biology and microbiology)

And clinical problem-solving in the following areas:

  • Caring
  • Communication and documentation
  • Teaching and learning
  • Culture and spirituality

According to the NCSBN test plan, the distribution of content for the NCLEX-PN exam through March 31, 2023, is as follows:

Safe and Effective Care Environment

  • Advance Directives
  • Advocacy
  • Client Care Assignments
  • Client Rights
  • Collaboration with Interdisciplinary Team
  • Concepts of Management and Supervision
  • Confidentiality/Information Security
  • Continuity of Care
  • Establishing Priorities
  • Ethical Practice
  • Informed Consent
  • Information Technology
  • Legal Responsibilities
  • Performance Improvement (Quality Improvement)
  • Referral Process
  • Resource Management
  • Accident/Error/Injury Prevention
  • Emergency Response Plan
  • Ergonomic Principles
  • Handling Hazardous and Infectious Materials
  • Home Safety
  • Reporting of Incident/Event/Irregular Occurrence/Variance
  • Least Restrictive Restraints and Safety Devices
  • Safe Use of Equipment
  • Security Plan
  • Standard Precautions/Transmission-Based Precautions/Surgical Asepsis
  • 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
  • Community Resources
  • Abuse/Neglect
  • Behavioral Interventions
  • 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
  • Substance Use and Other Disorders and Dependencies
  • Support Systems
  • Therapeutic Communication
  • Therapeutic Environment

Physiological Integrity

  • Assistive Devices
  • Elimination
  • Mobility/Immobility
  • Non-Pharmacological Comfort Interventions
  • Nutrition and Oral Hydration
  • Personal Hygiene
  • Postmortem Care
  • Rest and Sleep
  • Adverse Effects/Contraindications/Side Effects/Interactions
  • Dosage Calculation
  • Expected Actions/Outcomes
  • Medication Administration
  • Pharmacological Pain Management
  • Changes/Abnormalities in Vital Signs
  • Diagnostic Tests
  • Laboratory Values
  • Potential for Alterations in Body Systems
  • Potential for Complications of Diagnostic
  • Potential for Complications from Surgical Procedures and Health Alterations
  • Therapeutic Procedures
  • Alterations in Body System
  • Basic Pathophysiology
  • Fluid and Electrolyte Imbalances
  • Medical Emergencies
  • Unexpected Response to Therapies

Test Length and Format:

[Click here to see adjustments to the length of exam due to the COVID-19 pandemic]

The NCLEX-RN is a variable length computerized adaptive test and can range from 75 to 265 items. Of these items, 15 are pretest items that are not scored. The NCLEX-PN is a variable length computerized adaptive test and can range from 85 to 205 items. Of these items, 25 are pretest items that are not scored.

The types of questions a student can expect to see on the exams are:

  • Single best response items (radio button)
  • Multiple-response items that require a candidate to select all correct responses (Only ONE option or up to ALL options may be correct) 
  • 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 is a computer adaptive test (CAT) that presents items based on the candidate’s ability level. The item selection algorithm is designed for maximum efficiency. Items are not random; items are selected in response to the candidate’s previous answers.

The first item on the test will generally be one of intermediate difficulty. This is because the computer has no knowledge of a candidate’s knowledge prior to the exam. If the candidate answers incorrectly, an item of similar difficulty or lesser difficulty will be presented. Conversely, when a candidate answers an item with an intermediate level of difficulty correctly, the computer will next present an item of increased difficulty — an item that the candidate should have a 50% chance of answering correctly.
With each answer given, the computer re-estimates a candidate’s ability based on the answer given and the difficulty of the question asked. In other words, the difficulty of the test is tailored to a candidate’s level of knowledge. This is how the computer assesses true level of competency.

With each item answered, whether correct or incorrect, the test’s estimate of a candidate’s ability becomes more precise. Therefore, candidates should not take the NCLEX with the expectation that they will be able to answer every item correctly.

Grading Information:

As a pass/fail exam, candidates can face a few different scenarios as the computer determines the level of nursing competency.

The 95% Confidence Interval Rule is the most common scenario test takers experience. The computer stops administering items when it has ascertained with a 95% certainty that the candidate is clearly below or clearly above the passing standard. This can happen with the administration of the minimum number of required items or at any number thereafter.

Another scenario, the Maximum-Length Exam, is what candidates face whose competency levels are very close to the passing standard. In this scenario, the computer will continue to administer questions until the maximum number of items have been assigned. At that point in time, the computer will give a final estimate (pass or fail) as to the candidate’s level of readiness.

A third scenario is called the Run-Out-of-Time Rule (R.O.O.T.). In this scenario, the candidate runs out of time before the computer has determined with a 95% certainty that the candidate has passed or failed and before the maximum number of items have been completed. In this scenario, assuming the minimum number of items have been answered, the computer will evaluate the last 60 ability estimates to determine if the candidate’s answers were consistently above or below the passing threshold.

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