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A Brief Introduction to The NCLEX Exam

Up until 1944, each state administered its own licensure examination for nurses. Obviously, this made moving from state to state more difficult. In 1944, the National League for Nursing created the State Board Test Pool Examination (SBTPE), which was then adopted by all 50 states. This was the initial name for the NCLEX. In 1978, the National Council of State Boards of Nursing (NCSBN) took over administration over the exam. Since then the number of questions has been reduced from a maximum of 720 to a maximum of 265 (some test-takers only take 75).

The NCSBN has voted to raise the NCLEX-RN passing standard by increasing the number of questions an applicant had to get correct, most recently effective April 1, 2013. For the NCLEX-PN, the most recent increase was effective April 1, 2014. NCSBN administers a survey to practicing nurses every 3 years in order to adapt the test to the dynamics of the field and change the test every 3 years.

Each test taker takes a computerized test and has five hours to complete it. Fifteen of the questions don’t count and are merely trial questions for future exams. Some NCLEX takers may be selected to participate in the Next Generation NCLEX Project by answering additional questions that are estimated to take 30 minutes to complete. Since July 2017, the Special Research Section has allowed candidates to participate in the future development of NCSBN exams. The Special Research Section follows the regular exam and will not count as part of your NCLEX score.
All questions on the NCLEX examination and in the Special Research Section are confidential.

One of the important things to remember about the exam is that it is trying to assess entry-level nursing knowledge. Although it may be thought of as more prestigious to get intensive care (ICU) internship while still in school or to do your final practicum in labor & delivery, that may not be the best preparation for the NCLEX. The NCLEX is testing entry-level nursing knowledge and is geared towards acute care but not necessarily critical care skills. Niche experiences while in school may help launch your career into that specialty but make sure you study the basics in preparation for the exam.

Unlike many school exams, the NCLEX is not just testing content but also how one applies that content. For example, it will probably not ask you “what is this drug for?” But it might give you a scenario where a patient was administered 10mg IV hydralazine PRN and ask you for an appropriate nursing intervention after giving that drug. You would have to recognize that hydralazine is typically given for hypertension. Then as the drug was given PRN or “as needed”, the appropriate nursing intervention would be to check the blood pressure 30-60 minutes after giving the drug. The NCLEX is testing on how you can synthesize knowledge to care for patients.

The NCLEX-RN tests on four Client Need categories. Two of these are broken down into sub-categories. They tell you the percentage of items from each category that will be on the test.

  • 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 Parental Therapies (12-18%)
    • Reduction of Risk Potential (9-15%)
    • Physiological Adaption (11-17%)

The NCLEX-PN (Practical Nursing) tests on the same four Client Need categories with one subcategory modified, but their percentages are slightly different. The NCLEX-PN tests a minimum of 85 questions and a maximum of 205 questions. It is also evaluated every 3 years in a similar fashion to the NCLEX-RN. Because it is similar to the NCLEX-RN, many things that I mention in these blogs will apply to either.

  • Safe and Effective Care Environment
    • Coordinated Care (13-19%)
    • Safety and Infection Control (11-17%)
  • Health Promotion and Maintenance (7-13%)
  • Psychosocial Integrity (7-13%)
  • Physiological Integrity
    • Basic Care and Comfort (9-15%)
    • Pharmacological and Parental Therapies (11-17%)
    • Reduction of Risk Potential (9-15%)
    • Physiological Adaption (9-15%)

We’ll go more into these categories and give you examples in future blogs. Just remember as you are studying to think of how actions influence your patients.