NCLEX-RN: What to Expect?

The NCLEX-RN is administered to nursing school graduates to test the knowledge, abilities, and skills necessary for entry-level safe and effective nursing practice. The examination is developed by the National Council of State Boards of Nursing, Inc., an organization with representation from all state boards of nursing. The same examination is used in all 50 states, the District of Columbia, and United States possessions. Students who have graduated from baccalaureate, diploma, and associate degree programs in nursing must pass this examination to meet licensing requirements in the United States.

The National Council of State Boards of Nursing, Inc. prepares the test plan used to develop the licensing examination. The test plan, or framework of the examination, is based on the results of a job analysis conducted every 3 years of the entry-level performance of newly licensed registered nurses and on expert judgment provided by members of the National Council’s Examination Committee and a Job Analysis Panel of Experts. The questions are written by nurse clinicians and nurse educators nominated by the Council of State Boards of Nursing to serve as item writers, and they reflect nursing practice in all parts of the country.

The questions for the test are formulated on health care situations that registered nurses commonly encounter, addressing two components: (1) client needs categories and (2) integrated concepts and process such as the nursing process, caring, communication and documentation, cultural awareness, self-care, and teaching/learning. Representative items test knowledge of these components as they relate to specific health care situations in all of the four major areas of client needs. The questions developed for the test plan were written to test knowledge, comprehension, application, and analysis of nursing knowledge at these levels of the cognitive domain; most of the questions on the NCLEX-RN test at the level of application and analysis.

Each test item of the NCLEX-RN has been developed as a performance-based multiple choice question. The background (situation) is a client-based scenario that gives information about the client that is needed to answer the question. The question that follows is based on the information given in the situation. As you answer the question, relate the answer to the background information. Pay particular attention to information about the client’s age, family status, health status, ethnicity, or point in the care plan (eg, early admission versus preparation for discharge).

The stem (question) poses the problem to solve. The stem may be written as a direct question, such as, "What should the nurse do first?" or as an incomplete sentence, such as, "The nurse should:".

The answers (options) are possible responses to the stem (question). Each stem has one correct option and three incorrect options. The options may be written as complete sentences or may complete the sentence stated as a question.

The test questions also use figures, diagrams, and tables to frame the question and answers. For example, the candidate may be asked to look at an ECG strip and analyze the data or determine nursing priorities. The test questions will also use figures and diagrams to ask the candidate to identify parts of a figure (eg, to identify the location for the site of an intramuscular injection).

Test questions are presented on the computer screen (monitor); you select your answer and use the keyboard or a mouse to enter your answer. This CD-ROM provides you with an opportunity to simulate taking computer-generated examinations. At every testing site, written directions are provided at each computer exam station. There are also tutorials and practice questions on the computer that you can complete to be sure you understand how to use the computer before you begin the exam.

The NCLEX-RN is administered using computer-adaptive testing (CAT) procedures. CAT uses a computer to randomly generate questions from an item pool in order to administer individually tailored examinations. CAT has several advantages. For example, an exam can be given in less time because there are potentially fewer questions for each candidate. CAT exams can also be administered frequently, allowing a graduate of a nursing program to take the exam close to graduation, receive the results quickly, and enter the work force as a registered nurse in less time than is possible with paper and pencil exams. Study results also show that because CAT is self-paced, there is less stress on the candidate.

CAT uses the memory and speed of the computer to administer a test for each candidate. The test is generated from a large pool of questions (a test item bank) based on the NCLEX-RN test plan. The examination begins as the computer randomly selects a question of medium difficulty for each candidate. The next question is based on the response to the previous question. If the question is answered correctly, an item of similar or greater difficulty is generated; if it is answered incorrectly, a less difficult item is selected. Thus, the test is adapted for each candidate. Once competence has been determined, the exam is completed at a passing level.

The exams for all candidates are derived from the same large pool of test items. They contain comparable questions for each component of the test plan. Although the questions are not exactly the same, they test the same knowledge, skills, and abilities from the test plan. All candidates must meet the requirements of the test plan and achieve the same passing score. Each candidate, therefore, has the same opportunity to demonstrate competence. Although one candidate may answer fewer questions, all candidates have the opportunity to answer a sufficient number of questions to demonstrate competence until the stability of passing or failing is established or the time limit expires.

For further information about the NCLEX-RN, the test plan, test questions, or exam format, visit the Council’s Website at, or write to the National Council of State Boards of Nursing, Inc. For information about the dates, requirements, and specifics of writing the examination in your state, contact your state board of nursing. The addresses and telephone numbers of the National Council of State Boards of Nursing, Inc. and each state board of nursing are provided in the Appendix of the accompanying review book.

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