A Practical Guide to NCLEX-RN: Practice Questions, Tips, and Resources for Nurses
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The world of nursing is rewarding and demanding. Before entering this honorable profession, a critical test bridges the gap between academic learning and professional practice: the National Council Licensure Examination for Registered Nurses, or the NCLEX-RN.
A nursing degree is a prerequisite for becoming a registered nurse (RN), but students do not automatically become licensed nurses upon graduating. The final step in this process is passing the NCLEX-RN. This rigorous assessment is designed to measure entry-level nurses’ understanding, skills, and essential abilities necessary for safe and efficient nursing practice.
Unlock strategies to pass the NCLEX-RN with this guide to the test, methodology, and preparation.
The Structure of the NCLEX-RN
The NCLEX-RN test is delivered via computerized adaptive testing (CAT) technology, which tailors the difficulty of questions based on an individual’s responses, adjusting in real time to evaluate the test-taker’s ability.
As they answer questions correctly, subsequent questions may become more challenging; conversely, incorrect answers may lead to simpler questions. This dynamic approach provides a precise assessment of a candidate’s proficiency in a shorter span of questions.
To effectively prepare for the NCLEX-RN exam, it’s essential to understand its structure. The exam is organized into four primary sections.
Section 1: Safe and Effective Care Environment
This section focuses on a candidate’s ability to cultivate a safe and nurturing environment for both patients and healthcare practitioners. Subsections include:
- Management of Care: Emphasizes actions like advocacy, assignment, delegation, supervision, advance directives, and case management.
- Safety and Infection Control: Consists of key focus areas including accident and injury prevention, error prevention, executing emergency response plans, and managing hazardous or infectious materials.
Section 2: Health Promotion and Maintenance
This category spotlights early detection of health problems, illness prevention, and client education. It also touches on understanding growth and development principles.
Section 3. Psychosocial Integrity
The focus of this segment is on bolstering the emotional, mental, and social well-being of patients, especially those with chronic or acute mental health issues or those facing stressors.
Section 4: Physiological Integrity
This category evaluates aspiring nurses’ knowledge and critical thinking in fostering health and wellness, including care provision, risk minimization, and health adjustments. Subsections include:
- Basic Care and Comfort: Revolves around assisting patients in daily life activities. It evaluates the usage of assistive devices and the concepts of elimination and mobility.
- Reduction of Risk Potential: Evaluates a candidate’s proficiency in reducing the chances of complications. It delves into vital signs changes and abnormalities, the significance of diagnostic tests, laboratory values interpretation, and the potential for alterations in body systems.
- Pharmacological and Parenteral Therapies: Focuses on the administration of treatments and medications. Key subjects include adverse effects, contraindications, and understanding total parenteral nutrition.
- Physiological Adaptation: Explores care provision for patients with acute, chronic, or life-threatening conditions. Topics include body system alterations, understanding pathophysiology, and effective illness management.
The Newest Section: Unfolding Case Studies
A recent addition to the NCLEX-RN exam is the Unfolding Case Studies section. Presented in a medical record style, these case studies aim to gauge a candidate’s capacity for critical thinking and sound clinical decision-making throughout various client care stages. All candidates will navigate through three case studies, each comprising six test items.
NCLEX-RN Scoring System
The addition of Unfolding Case Studies came with NCLEX’s adoption of the Next-Generation NCLEX (NGN) on April 1, 2023. In this new format, candidates answer between 85 and 150 items. Fifteen of these items will be unscored, but they will be used for future exam development.
Scoring methodologies used in the NCLEX-RN include dichotomous scoring, where each question is either right (awarded one point) or wrong (given zero points), and polytomous scoring, where partial credit can be awarded.
How to Pass the NCLEX-RN
The NCLEX-RN is graded on a pass/fail basis. A passing score for the NCLEX-RN is 0.00 logits and above, meaning a candidate answered enough questions correctly.
After taking the exam, those who pass will move forward in the licensure process, while others will receive a summary of areas for improvement. Test-takers are permitted up to eight retakes per year with a 45-day waiting period between each test.
NCLEX-RN Practice Questions
Even with the introduction of new scoring methodologies, the NCLEX-RN continues to utilize familiar question formats like:
- Highlight
- Bowtie
- Cloze
- Drag-and-Drop
- Extended Multiple Responses
- Fill-in-the-Blank Numeric
- Matrix/Grid
- Hotspot
- Prioritization
Highlight
A highlight question requires candidates to identify and emphasize specific portions or segments of text that are most relevant to the provided clinical scenario or query. Here is an example:
Question:
Given the following patient note, highlight the segment that indicates an immediate medical concern:
“Mr. Anderson, a 68-year-old male with a history of hypertension, mentions he occasionally feels a slight chest pain when climbing stairs. Recently, he has adopted a new vegetarian diet and has been experiencing frequent gas and bloating. He also mentions sporadic episodes of dizziness when standing up.”
Answer:
“occasionally feels a slight chest pain when climbing stairs.”
Bowtie
A bowtie question presents candidates with a central concept or situation, and they are required to match or connect related elements or interventions from both sides, forming a “bowtie” pattern of relationships or correlations. Here is an example:
Question:
Given the central symptom of “Shortness of Breath,” match the potential causes on the left and the appropriate interventions on the right:
| Causes | Interventions |
|---|---|
| A) Fluid overload | 1) Administer bronchodilators |
| B) Asthma attack | 2) Implement deep-breathing exercises |
| C) Anxiety attack | 3) Restrict fluid intake |
Answer:
A) Fluid overload ➔ 3) Restrict fluid intake
B) Asthma attack ➔ 1) Administer bronchodilators
C) Anxiety attack ➔ 2) Implement deep-breathing exercises
Cloze
A cloze question is a fill-in-the-gap style item where candidates must provide a specific word or short phrase to complete a sentence or statement accurately and contextually relevant to the clinical scenario presented. Here is an example:
Question:
“A patient with Type 1 diabetes experiencing shakiness, sweating, and palpitations likely has low blood glucose levels and may be in ________.”
Answer:
“Hypoglycemia”
Drag-and-drop
A drag-and-drop question requires candidates to rearrange or place specific items or concepts into an order or category by dragging them from one area and dropping them into the correct position or grouping. Here is an example:
Question:
Drag and drop the following steps to correctly demonstrate the sequence for donning personal protective equipment (PPE):
A) Put on mask or respirator
B) Put on gown
C) Put on gloves
D) Put on goggles or face shield
Answer:
B) Put on gown
A) Put on mask or respirator
D) Put on goggles or face shield
C) Put on gloves
Extended Multiple Responses
An extended multiple responses question presents candidates with a list of options from which they must select multiple correct answers, encompassing more depth or complexity than traditional multiple-choice items. Here is an example:
Question:
Which of the following are common signs of congestive heart failure? (Select all that apply.)
A) Swollen ankles and feet
B) Persistent cough or wheezing
C) Sudden weight loss
D) Shortness of breath
E) Increased urine output at night
Answer:
A) Swollen ankles and feet
B) Persistent cough or wheezing
D) Shortness of breath
E) Increased urine output at night
Fill-in-the-blank Numeric
A fill-in-the-blank numeric question requires candidates to input a specific numerical value, often related to dosage calculations or lab values, to accurately answer a given clinical scenario or query. Here’s an example:
Question:
A physician orders 50 mg of a medication. The hospital has the medication in a concentration of 25 mg/mL. How many mL should the nurse administer?
Answer:
2 mL
Matrix/Grid
A Matrix/Grid question presents candidates with a table-like structure where they must match or link specific items or concepts from one column to corresponding items or concepts in another column, allowing for the assessment of relationships or associations in a clinical context. Here’s an example:
Question:
Match the following medications to their primary therapeutic uses:
| Medication | Therapeutic Use |
|---|---|
| A) Furosemide | 1) Cardiovascular |
| B) Albuterol | 2) Diuretic |
| C) Lisinopril | 3) Asthma/COPD relief |
Answer:
| Medication | Therapeutic Use |
|---|---|
| A) Furosemide | 2) Diuretic |
| B) Albuterol | 3) Asthma/COPD relief |
| C) Lisinopril | 1) Cardiovascular |
Hotspot
A hotspot question presents candidates with a visual image, requiring them to identify a specific area or point on that image by “clicking” or marking the relevant spot, often to demonstrate knowledge of anatomy, medical procedures, or equipment. Here’s an example:
Question:
Click on the area of the heart where the mitral valve is located.
Answer:
On a diagram of a human heart, the candidate would click on the area between the left atrium and the left ventricle, where the mitral valve is situated.
Prioritization
A prioritization question challenges candidates to determine the most critical or immediate action to take in a given clinical scenario, often asking them to rank interventions or patient needs in order of importance or urgency.
Question:
You are a nurse in a busy medical unit and just received a shift report on four patients. Which patient should you assess first?
A) A patient with stable angina who is complaining of a mild headache.
B) A post-operative patient, 4 hours post-op, who has a urine output of 20 mL in the last hour.
C) A patient with diabetes whose blood sugar was 110 mg/dL two hours ago.
D) A patient with a history of seizures who is currently sleeping peacefully.
Answer:
B) A post-operative patient, 4 hours post-op, who has a urine output of 20 mL in the last hour.
How to Register for the NCLEX-RN Exam
About six weeks before graduating from nursing school, students will receive an application for licensure. Once all the completed forms and fees are submitted, which are defined by the local nursing regulatory body (NRB), graduates receive their Authorization to Test (ATT). This process includes registering and paying for the NCLEX-RN exam through Pearson VUE.
As of 2023, the base NCLEX registration fee for candidates seeking U.S. licensure is $200. Additional fees to take the exam may apply for international licensure or changes made to the exam type, language, or NRB after initial registration.
Once candidates receive their ATT, they can schedule an NCLEX-RN test date and time. Typically, nursing school graduates take the exam about 45 days post-graduation.
Study Tips
The NCLEX-RN serves as the bridge between a nurse’s educational journey and professional practice. Preparing for this exam requires a deep understanding of complex concepts. Here are some proven strategies to optimize your study efforts:
- Prioritize Practice: Familiarize yourself with the types and formats of questions by regularly taking NCLEX-RN practice tests. These help in understanding the exam’s pattern and build endurance for the actual test day.
- Grasp the Material: Instead of rote memorization, aim for comprehension. Relate the theoretical aspects to real-life scenarios, which will aid in retaining and applying knowledge.
- Master Time Management: During your practice sessions, set a timer. This helps gauge the pace at which you should answer questions and ensures that ample time is given to each question during the exam.
- Analyze Practice Test Results: After each test, review your answers. Focus on the questions you got wrong and try to understand the rationale behind the correct answers. This will highlight the areas where you need improvement and deepen your understanding.
- Seek Feedback: Consider studying in groups or seeking feedback from peers or mentors. Discussing and debating can uncover insights you might have missed. NCLEX-specific community forums like AllNurses offer opportunities to connect with other future nurses studying for the exam and learn from the collective wisdom of peers.
Track Your Progress: Use a journal or digital tool to track your progress over time. Noting down the areas you repeatedly struggle with will allow targeted revision and enhance your overall performance.
NCLEX-RN Study Guide
Preparing for the exam requires candidates to thoroughly review their entire nursing curriculum. Thankfully, there are tons of resources available to help.
NCLEX-RN Test Plan
Saunders Comprehensive Review for the NCLEX-RN Examination is a well-respected resource that will help develop a structured daily study plan, ensuring consistent progress to avoid last-minute cramming.
NCLEX RN Practice Tests
Platforms like UWorld and Kaplan curate mock tests to refine your understanding and approach while honing crucial test-taking techniques. Also, mobile apps like NCLEX-RN Mastery, which offers practice questions, mnemonics, terminology, quizzes, and progress tracking, can turn doom scrolling into productive exam reviews.
Free NCLEX RN Practice Tests
Free NCLEX-RN questions are available via various online resources. For example, Elegant eLearning’s NCLEX RN Genie app is loaded with 2,500+ questions based on the real NCLEX-RN exam to help you study for free.
Another free resource is Nurse.plus, which offers free practice tests and questions. The site also offers a premium service with additional questions and study materials.
To prepare for the Unfolding Case Studies section, download a sample pack of case studies for free on the NCSBN website here.
FAQs on the NCLEX
When do I know if I passed the NCLEX?
NCLEX can provide Quick Results for some candidates seeking licensure in the U.S. within two business days after taking their exam for a nominal fee of $7.95. The service is informational only and does not authorize candidates to practice as a licensed nurse. You can order your early NCLEX results via the NCLEX website.
It’s important to note that not all state boards of nursing participate in this service. The “official” results are typically mailed to candidates within six weeks.
Will I know which items are unscored when I’m taking the exam?
No, the unscored items will not be made known during the exam.
Who administers the NCLEX-RN exam?
The exam is developed and administered by the National Council of State Boards of Nursing (NCSBN), a not-for-profit organization whose U.S. members include the nursing regulatory bodies in the 50 states, the District of Columbia, and four U.S. territories: Puerto Rico, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands.
Can I skip questions and come back to them later during the exam?
No, the NCLEX-RN’s computer-adaptive format requires test-takers to answer each question presented before moving on to the next one. It’s essential to make the best possible choice for each question because there’s no option to return to it later
How often is the NCLEX-RN updated?
The NCLEX-RN undergoes regular reviews and updates to ensure the content remains current and relevant. The NCSBN typically reviews the test plan every three years, and any changes or updates are communicated to nursing programs and the public. The most recent update was April 1, 2023.
What are some practical tips to prepare for exam day?
- Arrive early: Ensure you reach the test center with ample time to spare. This will help you relax and mentally prepare without the stress of running late.
- Dress comfortably: Opt for layers, as testing centers can vary in temperature. Comfortable clothing will allow you to focus solely on the exam.
- Trust your instincts: Often, your first answer choice is the right one. Avoid second-guessing unless you’re certain of a mistake.
- Pace yourself: Be mindful of the time but don’t rush. If you’re unsure about a question, mark it and revisit it later.
What are some wellness tips to prepare for exam day?
- Prioritize sleep: Ensure you get a good night’s sleep, especially the nights leading up to the exam. Fatigue can impair cognitive function, which can impact your performance.
- Eat a balanced meal: On the morning of the exam, have a nutritious breakfast that includes proteins, complex carbs, and healthy fats. This will provide sustained energy and keep hunger pangs at bay.
- Stay hydrated: Drink water in moderate amounts. While it’s essential to stay hydrated, also remember to take restroom breaks only during designated times to avoid disruptions.
- Manage stress: Utilize relaxation techniques like deep breathing exercises or brief meditations if you feel anxious. Remember, it’s natural to feel nervous, but controlling those nerves is key.
What should I do on exam day after I complete the test?
Post-exam, regardless of how you feel, give yourself time to decompress. Engage in an activity you enjoy, or simply rest.
Conquering the NCLEX-RN: A Bridge to Professional Nursing
The NCLEX-RN is the final barrier for aspiring nurses to conquer before transitioning into their professional roles. It is meticulously crafted to assess the depth and breadth of an aspiring nurse’s knowledge, skills, and critical thinking necessary for delivering optimal patient care.
But remember, the pathway to success lies in understanding the intricacies of the exam, practicing consistently, and seeking resources that aid in mastering the content and the methodology of the NCLEX-RN.
The world of nursing awaits candidates’ skills, compassion, and dedication.
Sharlys Leszczuk
Guest ContributorSharlys Leszczuk is the founder and owner of Shar-Liss, a creative, deep-thinking, insights-driven communications consultancy. She built her career counseling high-technology companies of all sizes – from not-for-profits and pre-seed startups to Fortune 100s – on messaging, communications, and go-to-market strategies. Her specialties include ghostwriting, content development, corporate communications, creative strategy, events, and social media, with a focus on project management, operations, and executive relations.
Born and raised in North Jersey, Sharlys received bachelor’s degrees in public relations and global studies from Hofstra University on Long Island. After graduating, she spent nearly a decade working for New York City PR agencies. Then, with the remote work flexibility afforded by the pandemic, she took an interest in roadtripping, which ultimately led her to relocate to Oregon. She is an active member of her small coastal community, Pacific City, where she spends her free time exploring the outdoors and activities such as hiking, biking, paddleboarding, and kayaking.