NCLEX stands for National Council Licensing Examination, it is a test to

determine if the candidate possesses the minimum level of knowledge

necessary to perform safe and effective entry-level nursing care. The NCLEX-RN
(for registered nurses) and the NCLEX-PN (for practical/vocational nurses) are
examinations prepared by the National Council of State Boards of Nursing
(NCSBN) whose mandate is to protect the public from unsafe nursing care. The
NCSBN members include nursing regulatory bodies in the 50 states of the US,
the District of Columbia and four US territories.

How to Register for the NCLEX?

So, you’ve finally made the decision to take the NCLEX, the next step is
registration or application for the exam. The following are the steps on how to
register for the NCLEX including some tips:

1. Application to the Nursing Regulatory Board (NRB).

The initial step in the registration process is to submit your application
to the state board of nursing in the state in which you intend to obtain
licensure. Inquire with your board of nursing regarding the specific
registration process as requirements may vary from state to state.

2. Registration with Pearson VUE.

Once you have received the confirmation from the board of nursing
that you have met all of their state requirements, proceed, register,
and pay the fee to take the NCLEX with Pearson VUE. Follow the
registration instructions and complete the forms precisely and
accurately.

3. Authorization to Test.
If you were made eligible by the licensure board, you will receive an
Authorization to Test (ATT) form from Pearson VUE. You must test
within the validity dates (an average of 90 days) on the ATT. There are
no extensions, or you’ll have to register and pay the fee again. Your
ATT contains critical information like your test authorization number,
validity date, and candidate identification number.

4. Schedule your Exam Appointment.

The next step is to schedule a testing date, time, and location at
Pearson VUE. The NCLEX will take place at a testing center, you can
make an exam appointment online or by telephone. You will receive a
 confirmation via email of your appointment with the date and time you
choose including the directions to the testing center.

*Changing Your Exam Appointment. You can change your

appointment to test via Pearson VUE or by calling the candidate
services. Failing to arrive for the examination or failure to cancel your
appointment to test without providing notice will forfeit your
examination fee and you’ll have to register and pay again.

5. On Exam Day.
Arrive at the testing center on your exam appointment date at least 30
minutes before the schedule. You must have your ATT and acceptable
identification (driver’s license, passport, etc.) that is valid, not expired,
and contains your photo and signature.

6. Processing Results.
You will receive your official results from the board of nursing after six
weeks.

Computer Adaptive Test (CAT)

Like most standardized tests today, the NCLEX is administered by a computer.
The NCLEX uses computer adaptive test (CAT) which reacts to the answers you
give to determine your level of competence. The selection of questions is based
on the NCLEX-RN test plan and by the level of item difficulty.

Every time you answer a question, the computer reevaluates your ability based
on all the previous answers and difficulty of those test items. Your first question
is relatively easy, if you selected a correct answer, the computer supplies you
with a more difficult question from its question bank. If you have selected an
incorrect answer, the computer gives you an easier question. This process
continues throughout the examination until the test plan requirements are met
and the computer can determine your level of competence.

Additionally, there is no option to skip a question, you must answer it or the

test will not move on. You cannot go back and review previous questions and
change answers.
NCLEX-RN Test Plan
The NCLEX test plan is a content guideline to determine the distribution of test
questions. NCSBN uses the “Client Needs” categories to ensure that a full
spectrum of nursing activities is covered by the NCLEX. It is a summary of the
content and scope of the NCLEX to serve as a guide for candidates preparing for
the exam and to direct item writers in the development of items. The content
of the NCLEX-RN is organized into four major Client Needs categories which
include: Safe and Effective Care Environment, Health Promotion and
Maintenance, Psychosocial Integrity, Physiological Integrity. Some of these
categories are divided further into subcategories.

Below is the NCLEX-RN test plan effective as of April 2019 to March 2022:

Percentage of
Items from
NCLEX-RN Client Needs
Each
Category

Safe and Effective Care Environment

Management of Care 17-23%

Safety and Infection Control 9-15%

Health Promotion and Maintenance 6-12%

Psychosocial Integrity 6-12%

Physiological Integrity

Basic Care and Comfort 6-12%

Pharmacological and Parenteral Therapies 12-18%

Reduction of Risk Potential 9-15%

 Percentage of
Items from
NCLEX-RN Client Needs
Each
Category

Physiological Adaptation 11-17%

Safe and Effective Care Environment

There are two subcategories under Safe and Effective Care Environment.

• Management of Care (17-23%) category includes content that tests

the nurse’s knowledge and ability to direct nursing care that enhances
the care delivery setting in order to protect clients, significant others,
and health care personnel.
• Safety and Infection Control (9-15%) category includes content
that tests the nurse’s ability required to protect clients, families, and
health care personnel from health and environmental hazards.

Health Promotion and Maintenance

Health Promotion and Maintenance (6-12%) category includes content
that tests the nurse’s ability to provide and direct nursing care of the client that
incorporates knowledge of expected growth and development; preventing and
early detection of health problems, and strategies to achieve optimal health.

Psychosocial Integrity
The Psychosocial Integrity category (6-12%) are content related to the
promotion and support for emotional, mental, and social well-being of the client
experiencing stressful events, as well as clients with acute or chronic mental
illness.
Physiological Integrity
In the Physiological Integrity category are items that test the nurse’s ability to
promote physical health and wellness by providing care and comfort, reducing
risk potential and managing health alterations. There are four subcategories
under Physiological Integrity.

• Basic Care and Comfort (6-12%) are content to test the nurse’s
ability to provide comfort and assistance to the client in the
performance of activities of daily living.
• Pharmacological and Parenteral Therapies (12-18%) category
includes content to test the nurse’s ability to administer medications
and parenteral therapies (IV therapy, blood administration, and blood
products).
• Reduction of Risk Potential (9-15%) category includes content to
tests the nurse’s ability to prevent complications or health problems
related to the client’s condition or prescribed treatments or
procedures.
• Physiological Adaptation (11-17%) category includes questions
that test the nurse’s ability to provide care to clients with acute,
chronic, or life-threatening conditions.

Item Writers for NCLEX

Who writes questions for the NCLEX? The NCSBN sets the criteria and selection
process for item writers who are registered nurses. Many of them are nursing
educators who hold an advanced degree in nursing so if you’ve completed an
accredited nursing program, you have already taken several tests written by
nurses with backgrounds similar to those who write for the NCLEX.

Testing Time
The maximum testing time for the NCLEX-RN is six (6) hours and there is no
time limit for each individual NCLEX question. The exam time includes all the
tutorials and all the breaks. The first break is offered after two (2) hours, the
second break is offered after 3.5 hours of testing. All breaks are optional, and
most test-takers may not need the full time to complete the examination.
How to Pass the NCLEX?
The NCSBN indicates that a pass-or-fail decision is governed by these three
rules: 95% Confidence Interval Rule, Maximum-Length Exam Rule, and Run-
Out-Of-Time Rule.

95% Confidence Interval Rule

In this scenario, the computer stops administering test questions when it is
95% certain that your ability is clearly above the passing standard or clearly
below the passing standard.

Maximum-Length Exam
When your ability is close to the passing standard, the computer continues to
give you items until the maximum number of items is reached. At this point, the
computer disregards the 95% confidence rule and decides whether you pass or
fail by your final ability estimate. If your final ability estimate is above the
passing standard, you pass; if it is below, you fail.

Run-Out-Of-Time (R.O.O.T.) Rule

When you run out of time before reaching the maximum number of items, the
computer has not been able to decide whether you passed or failed with 95%
certainty and has to use an alternate rule. If you have not answered the
minimum number of required questions, you fail. If you have at least answered
the minimum number of items, the computer reviews your last 60 questions. If
your ability estimate was consistently above the passing standard on the last 60
questions, you pass. If your ability dropped below the passing standard, even
once, during your last 60 questions, you fail.

How many questions are on the NCLEX?

For the NCLEX-RN, the minimum number of questions you need to answer is 75
while the maximum number in the test is 265. Regardless of the total number
of questions you answer, you are given 15 questions that are experimental
(pretest questions). Pretest questions are indistinguishable from other questions
on the test, not indicated as such, are being tested for future examination and
not counted against your score.
Question Types in the NCLEX-RN
Although most NCLEX items are multiple-choice, there are other formats as
well. You may be administered multiple-choice items and questions written in
alternate formats. These formats may include: multiple-response or select all
that apply, fill-in-the-blank calculation, ordered response, hotspot, figure, chart
or exhibit, graphic, audio, and video.

Multiple-Choice Questions
Many questions on the NCLEX are in multiple-choice format. This traditional
text-based question will provide you data about the client’s situation and you
can only select one correct answer from the given four options. Multiple-choice
questions may vary and include audio clips, graphics, exhibits or charts.

Chart or Exhibit Questions

A chart or exhibit is presented along with a problem. You’ll be provided with
three tabs or buttons that you need to click to obtain the information needed to
answer the question. Select the correct choice among four multiple-choice
answer options.

Graphic Option
In this format, four multiple-choice answer options are pictures rather than text.
Each option is preceded by a circle that you need to click to represent your
answer.

Audio
In an audio question format, you’ll be required to listen to a sound to answer
the question. You’ll need to use the headset provided and click on the sound
icon for it to play. You’ll be able to listen to the sound as many times as
necessary. Choose the correct choice from among four multiple-choice answer
options.

Video
For the video question format, you are required to view an animation or a video
clip to answer the following question. Select the correct choice among four
multiple-choice answer options.
Select All That Apply or Multiple-Response
Multiple-response or select all that apply (SATA) alternate format question
requires you to choose all correct answer options that relate to the information
asked by the question. There are usually more than four possible answer
options. No partial credit is given in the scoring of these items (i.e., selecting
only 3 out of the 5 correct choices) so you must select all correct answers for
the item to be counted as correct.

Tips when answering Select All That Apply Questions

• You’ll know it’s a multiple-response or SATA question because you’ll

explicitly be instructed to “Select all that apply.”
• Treat each answer choice as a True or False by rewording the question
and proceed to answer each option by responding with a “yes” or “no”.
Go down the list of answer options one by one and ask yourself if it’s a
correct answer.
• Consider each choice as a possible answer separate to other choices.
Never group or assume they are linked together.

Fill-in-the-Blank
The fill-in-the-blank question format is usually used for medication calculation,
IV flow rate calculation, or determining the intake-output of a client. In this
question format, you’ll be asked to perform a calculation and type in your
answer in the blank space provided.

Tips when answering Fill-in-the-Blank

• Always follow the specific directions as noted on the screen.

• There will be an on-screen calculator on the computer for you to use.
• Do not put any words, units of measurements, commas, or spaces with
your answer, type only the number. Only the number goes into the
box.
• Rounding an answer should be done at the end of the calculation or as
what the question specified, and if necessary, type in the decimal
point.
Ordered-Response
In an ordered-response question format, you’ll be asked to use the computer
mouse to drag and drop your nursing actions in order or priority. Based on the
information presented, determine what you’ll do first, second, third, and so
forth. Directions are provided with the question.

Tips when answering Ordered-Response questions

• Questions are usually about nursing procedures. Imagine yourself

performing the procedure to help you answer these questions.
• You’ll have to place the options in correct order by clicking an option
and dragging it on the box on the right. You can rearrange them before
you hit submit for your final answer.
• Questions are usually about nursing procedures. Imagine yourself
performing the procedure to help you answer these questions.
• You’ll have to place the options in correct order by clicking an option and
dragging it on the box on the right. You can rearrange them before you
hit submit for your final answer.

Hotspot
A picture or graphic will be presented along with a question. This could contain
a chart, a table, or an illustration where you’ll be asked to point or click on a
specific area. Figures may also appear along with a multiple-choice question. Be
as precise as possible when marking the location.

Tips when answering Hotspot questions

• Mostly used to evaluate your knowledge of anatomy, physiology, and

pathophysiology.
• Locate anatomical landmarks to help you select the location needed by
the item.