NCLEX: Preparing for the National Council Exam for Registered Nurses

The NCLEX-RN® consists of questions from the cognitive levels of knowledge, comprehension, application, and analysis. The majority of questions are written at the application and analysis levels. Questions incorporate the five stages of the nursing process (assessment, diagnosis, planning, implementation, and evaluation) and the four categories of client needs. Client needs are divided into subcategories that define the content within each of the four major categories. These categories and subcategories are:




Taking the Computerized Adaptive Test
Computer Adaptive Testing offers the candidate several advantages. The graduate can schedule the exam at a time that is convenient for him. 
Because you might not be familiar with the Pearson testing centers, we recommend that you arrive at least 30 minutes early. If you are late, you will not be allowed to test. Bring two forms of identification with you, one of which must be a picture ID. Be sure that your form of identification matches your application. You will be photographed and fingerprinted upon entering the testing site, so don’t let this increase your stress. The allotted time has been extended from 5 hours to 6, and the candidate can receive results within approximately 7 days (in some states even sooner). Remember that the exam is written at approximately the 10th-grade reading level, so keep a good dictionary handy during your studies.

The Cost of the Exam
The candidate wishing to write the licensure exam must fill out two applications, one to the National Council and one to the state in which she wishes to be licensed. A separate fee must accompany each application. The fee required by the National Council is $200. State licensing fees vary from state to state. For example, in Mississippi the fee is $60. Licensure applications can be obtained on the National Council’s website at www.ncsbn.org. Several states are members of the multistate licensure compact. This means that, if you are issued a multistate license, you pay only one fee. This information can be obtained by visiting the National Council’s website as well.

The CAT Exam
The Computer Adaptive Test (CAT) provides a means of individualized testing of each candidate seeking licensure as a registered professional nurse.
Selecting from a large test bank, the computer chooses questions based on the candidate’s ability and competence as demonstrated on the prior question.
The minimum number of questions is 75, and the maximum number is 265.
The average candidate’s exam is comprised of 160 items. You must answer the question that appears on the screen before another question is given and cannot skip questions nor return to a previous question. It is imperative that you read each question carefully before selecting a response. We suggest that you cover the answers with your nondominant hand and read the stem before looking at the answers. A. you might have read in the introduction to this book, the NCLEX-RN® consists of questions from the cognitive levels of knowledge, comprehension, application, and analysis. The majority of questions are written at the application and analysis levels. Questions incorporate the five stages of the nursing process:
- Assessment
- Analysis
- Planning
- Implementation
- Evaluation

There are also questions from the four categories of client needs. Client needs are divided into subcategories that define the content within each of the four major categories. According to www.NCSBN.org, these categories and subcategories, as well as the percentages of questions allocated to each area, are as shown in the following table.


A- Management of Care
- Safety and Infection Control 8%–14%
B. Health Promotion and Maintenance 6%–12%
C. Psychosocial Integrity 6%–12%
D. Physiological Integrity
- Basic Care and Comfort
- Pharmacological and Parenteral Therapies
- Reduction of Risk Potential
- Physiological Adaptation 43%–67%

Computerized Adaptive Testing offers the candidate several advantages over the former paper pencil exam. The test questions, which are stored in a large test bank and classified by test plan areas and level of difficulty, are administered to the candidate. Depending on the answer given by the graduate, the computer presents another question that is either more difficult or less difficult. This allows the computer to determine the candidate’s knowledge of the subject matter more concisely.
The pass/fail decision is not based on how many questions the candidate answers correctly, but on the difficulty of the questions answered correctly.
Even though candidates might answer different questions and different numbers of questions, the test plan remains the same. All NCLEX-RN® examinations conform to this test plan. Each time you answer a question correctly the next question gets harder until you miss a question; then an easier question is given until you answer correctly. This way the computer concludes if a candidate has met the passing standard. If you are clearly above the passing standard at 75 questions, the computer stops asking questions. If you are clearly below the passing standard, the computer stops asking questions. If your ability estimate is close to the passing standard, the computer continues to ask questions until either the maximum number of questions is asked or time expires. Should time expire, the last 60 questions are reviewed.
To pass, the candidate must remain above the passing standard on the last 60 items.
The CAT exam offers another advantage. The candidate can schedule the exam at a time that is convenient for her; the candidate usually receives test results in 7 days or sooner. The candidate can retake the exam after 45 days in most states. We suggest that you review this text and others, and, if needed, take a review seminar prior to taking the NCLEX®. Allow at least one week to study and prepare for the exam. Remember: You want to take the exam only one time.