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What is the Difference Between the NCLEX-RN & NCLEX-PN Exams?

As I reviewed in a previous blog, the RN and PN NCLEX tests have the same categories with one difference – in the care subcategory, which falls underneath “Safe Effective Care Environment”.  They also have unique percentages devoted to the categories, altering the distribution of the content questions.  We can go into that more in a future blog.

The care subcategory of the RN test is called “Management of Care” and is 17-23% of the questions (NCSBN, 2019a).  The care subcategory of the PN test is called “Coordinated Care” and is 13-19% of the questions (NCSBN, 2020).  This subcategory is obviously important on either test since it can make up 1/5th of the exam showing the important role nurses have in inpatient care!

What’s the difference you ask?  Valid question…let us explore.  So what the NCSBN does is every 3 years they survey LPNs/VNs for the PN test and RNs for the RN test.  They then compile a very comprehensive practice analysis of what RNs and LPNs do and make the NCLEXs accordingly.  So content will vary as laws modify to change practice for LPN/VNs and RNs.

So a brief view is that the RN “Management of Care” subcategory includes content that tests case management and patient teaching such as discharge care.  These are distinctive to the NCLEX-RN.  Meanwhile, the PN “Coordinated Care” subcategory tests participation in case management and patient teaching.

The major legal difference between RNs and LPNs is that RNs can diagnose human responses, develop plans of care for patients, screen patients that might be at risk, care for complex/unstable patients, and conduct patient teaching/discharging/admitting.  LPNs, however, usually care for more stable patients under the supervision of an RN and participate in collecting important data that can lead to diagnosis and case management. (NSCBN, 2018, 2019b)

All in all, the categories are more similar than divergent.  The types of things that you might see in this section on both tests include the following list: advance directives, advocacy, client rights, interdisciplinary collaboration, information security, management concepts, continuity of care, priorities, ethics, informed consent, information technology, legal responsibilities, quality improvement, and the referral process.

So, what does this look like when you are sitting in front of the NCLEX?

A question to an RN might look like this:

A 42-year-old male patient is admitted to your medical-surgical unit at a community hospital in the month of May.  He has a history of Type 2 Diabetes Mellitus and End-Stage Renal Disease.  During your admission, you screen and recommend which of the following immunizations for him.

  1. Influenza live nasal spray
  2. Pneumococcal vaccination
  3. Influenza attenuated (dead) SQ injection
  4. HPV vaccine

Answer and Rationale:  The correct answer is B – the Pneumococcal vaccination.  Per Center for Disease Control (CDC, 2020) guidelines, this is recommended for any patient with chronic diabetes or kidney disease.  Influenza vaccines are given during the flu season, which is September – March.  The HPV vaccine is currently recommended for patients under age 26.

A similar yet different question might be asked to a PN test taker:

You are ordered to give a 42-year-old male patient that has Type 2 Diabetes Mellitus and End-Stage Renal Disease a Pneumococcal vaccination during his stay on your hospital medical-surgical unit.  When you go to give the vaccination, he mentions that he might have gotten it about 6 years ago but cannot remember and doesn’t have any documentation.  Should you still give it and why?

  1. No.  If he already got the vaccine, then he doesn’t need it again
  2. Yes.  A patient needs the vaccine every 5 years.
  3. No.  The scope of practice for PNs does not include SQ injections
  4. Yes.  If a patient is unsure, the CDC recommends vaccinating, as there is little potential harm but much potential benefit.

Answer and Rationale:  The correct answer is D.  According to the CDC, a patient recommended for the pneumococcal vaccination should receive it if it is unknown or unclear whether or not they are previously vaccinated.  A is not correct because the patient does not know if he received it.  B is not the best answer because an at-risk patient needs the vaccine once and in some rare cases twice.  C is erroneous because the scope of practice for PNs does include SQ injections (CDC, 2020).

What’s the difference?  The RN question involves screening and developing a plan of care for a vaccination.  Many hospitals have protocols that an RN can follow and they can actually order the vaccine after a screen.  LPNs are not able to do this with their scope of practice in most states because it involves developing a plan of care.  However, once ordered, an LPN can give a vaccine and follow appropriate pharmacological guidelines to administer it.

Thanks for reading!

- Nurse Amy


2019 NCLEX-RN Detailed Test Plan.  2019.  National Council of State Boards of Nursing (NCSBN).

2017 RN Practice Analysis: Linking the NCLEX-RN Examination to Practice - US & Canada (Vol. 72). 2018. National Council of State Boards of Nursing (NCSBN). https://www.ncsbn.org/17_RN_US_Canada_Practice_Analysis.pdf

2020 NCLEX-PN Detailed Test Plan.  2020.  National Council of State Boards of Nursing (NCSBN).

2018 LPN/VN Practice Analysis: Linking the NCLEX-PN® Examination to Practice (Vol. 75). 2019. National Council of State Boards of Nursing (NCSBN). https://www.ncsbn.org/LPN_Practice_Analysis_FINAL.pdf

Centers for Disease Control and Prevention. (2020, July 6). Immunization and Respiratory Diseases (NCIRD) Home. Centers for Disease Control and Prevention. https://www.cdc.gov/ncird/index.html.