How to Pass the NCLEX-RN®: The Ultimate Osmosis Guide

The NCLEX-RN test is long and time-consuming and makes nursing school grads nervous. However, with proper preparation, it can be conquered!

Congratulations on graduating from nursing school! Passing all those rigorous exams and grueling clinicals shows your dedication and skill. There is just one more critical step standing between you and your Registered Nursing license, and Osmosis is here to help you through it.

What is the NCLEX-RN®?

NCLEX stands for the National Council Licensure Examination. Nursing school graduates take this test to pass national and state requirements and receive their nursing license. There are two NCLEX exams. The NCLEX-RN is taken by those who want to get their registered nursing license. Practical nurses take the NCLEX-PN®.

The exam started in 1982 in the US; Canada first adopted the test in 2012, and it went into effect for live testing in 2015. The National Council of State Boards of Nurses® (NCSBN®) owns, develops, and administers the NCLEX-RN. Each state’s nursing board accepts the results of the NCLEX in order to bestow a state nursing license.

The NCLEX-RN is taken on a computer through Pearson VUE testing centers. The exam employs Computer Adaptive Technology (more on that below). The NCLEX-RN tests theoretical knowledge, practical skills, and level of critical thinking ability for each student who wants to enter the nursing profession. The test is designed to ensure that every new nurse is minimally competent to practice as a RN.

This standardization helps ensure client safety and ethical practices across the country.

How do I register for the exam?

The first step to registering is to contact your state or province Nursing Regulatory Board® (NRB®) for an application. There is a fee associated with submitting your application.

The second step is to register with the test administrator, Pearson VUE. You can do this online or over the phone. Then you’ll schedule your test through Pearson VUE.

How expensive is the NCLEX-RN?

The NCLEX exam comes with associated fees which you will need to pay before you can take the exam. You can pay by debit, credit, or prepaid card, or you can have your institution take care of the fees.

For more information on how much you’ll have to pay, check out these instructions on the NCSBN's Application & Registration page. Nursing.org also has an extremely helpful table breaking down the costs of the NCLEX, which you can view here.

What topics does the NCLEX-RN cover?

Generally, the exam covers the skills, knowledge, and practical ability of the nurse. The test follows the five step nursing process: assessment, diagnosis, planning, implementation, and evaluation (ADPIE).

Exam content is based on overall client needs. Since clientsand environments vary across a wide spectrum, expect a wide range of questions. We’ll go more in-depth on the question distribution and content areas below.

How often does the NCLEX-RN test format change?

The NCSBN continuously reviews and updates the questions and content of the exam to make sure that they are keeping up with current medical understanding, trends, and challenges. When nursing practices change, the relevant questions will be reviewed and revised as needed.

The NCLEX test plans are updated every three years and reflect any major changes to the exam. It is highly recommended that you review the NCSBN test plan in-depth before taking the exam.

There are also some significant changes ahead for the exam. In response to studies showing a lack of critical thinking skills among novice nurses, the NCSBN is creating the Next Generation NCLEX® (NGN®). This test will emphasize critical thinking abilities over rote memorization of tasks and information, which means truly learning material for the long-term will be much more important than cramming right before the exam.

What is Computer Adaptive Technology?

The NCLEX-RN employs Computer Adaptive Technology (CAT), which means that the computer re-calibrates the exam after each question you answer. This helps ensure that the exam is specific to your level of ability and is unique to each test-taker.

Each time you answer a question correctly, the computer chooses the next question out of its question bank that you’ll have a 50% chance of answering correctly. This means that the better you perform, the more difficult the questions will get. You shouldn’t read too much into the level of challenge you’re experiencing, though. The exam also randomly generates 15 non-scored questions of varying levels of difficulty. These are sample questions that may be used on future NCLEX-RN exams.

At the end of your exam, you must reach a certain passing level determined by the NCSBN, as this will demonstrate that you are minimally competent to begin practicing as a nurse.

How is the Computer Adaptive Technology exam different from a regular exam?

In a fixed-length test, each student is given exactly the same questions to complete in the same amount of time, creating a consistent experience across the board. However, each test-taker is different. In a fixed-length exam, students of high abilities must answer all easy questions, and low ability students will find themselves guessing at the difficult items.

CAT exams allow flexibility in the testing environment by targeting each student’s ability level and adapting to it. This provides a much more accurate reflection of each student’s particular abilities across a range of topics. Since the nursing practice demands such a range of knowledge, this type of testing is particularly suited for the NCLEX-RN exam.

How do you prepare for the NCLEX-RN?

The first thing to do after you graduate from school is to take a little bit of time to rest and recuperate. Nursing school is demanding, and you’re probably under-nourished both physically and emotionally.

Give yourself a week or two to recuperate. Sleep in, eat well, get some exercise and fresh air. It also helps to reconnect with friends and family who may not have seen you during long days of studying and working through school.

This R&R time includes your brain, too! The NCLEX-RN exam may take a month or two to prepare for, so practice managing your anxiety and try not to worry. When you’re prepared, you’ll feel much more calm and comfortable going into the test center come exam day.

After this mini-break, sit down and plan out your study schedule. Set your test date for a month or two out so that you give yourself enough study time. Each student is different, of course, but the general recommendation is to spend about three hours a day reviewing your nursing material.

How do you study for the NCLEX-RN?

As you’re probably aware after observing your peers at school, every student is different in study habits and needs. There are always those students who seem to be able to breeze through exams with minimal studying.

The rest of us, however, need time and a plan. These vary widely as well, of course, but we’ve gathered some tips from students who’ve taken the test and experts who study these things.

Step 1 - Organize

The very first thing to do is get organized. If it’s been awhile since you graduated from nursing school, your study space may have gathered dust, junk, or have been repurposed altogether. Create a clean, orderly, and above all quiet space. Make it comfortable, because you may be spending upwards of three to four hours a day studying.

Step 2 - Plan ahead

Get out your calendar and figure out how much time you have between now and your test date. Create a schedule that you can realistically stick to: which days will you be able to dedicate to studying? Do you have work or family obligations you’ll need to attend to? When will you take time to relax? Also plan out when you’ll take the practice exams; consider taking one early to gauge where your strengths lie, then sprinkle in a practice test here and there, with one of those being at least 2 weeks before you test.

Step 3 - Find a partner

One of the best ways to learn is by teaching the material to someone else. Demonstrating material helps you master it in a way that passive reading and studying can’t deliver. Schedule some reciprocal study sessions where you and your study partner can take turns explaining concepts and answering questions. These kinds of sessions can also go really far in bolstering your confidence, which is a big part of exam success.

Step 4 - Read the test plan

The NCSBN publishes an in-depth test plan every three years. It’s in your best interest to carefully read through the plan to get an idea of what to expect come test day. The test plan lays out content distribution in a detailed way and even gives sample exam items that give an excellent sneak peek into the test. The test plan also has very thoughtful things to say about the values and beliefs underlying the exam. This is an essential step that you should take early on and revisit throughout your studying.

Step 5 - Take a brain break before the actual exam

Don’t break your brain just before you sit down to the test! It’s important to rest your noggin, allow the knowledge to sink in, and lower your stress level. Creating this detailed schedule will reduce the need for cramming right before your test day. Give yourself a day or two off before the exam. Go for a hike, or shopping, or the beach - whatever you do to relax and take your mind off of things. Don’t worry, all of your hard work will not disappear in 24 short hours. Go into testing day refreshed and ready!

Other study tips and tricks

Here are a few other tips and tricks that candidates have used to pass the NCLEX-RN successfully.

Visualization

Picture the scenario the exam item describes. Place yourself in the setting with the client.

Mnemonics

There is value in memorizing some of the material by rote. Creating handy ways to remember facts and processes can help.

Study guides and prep courses

Though there is plenty of study material and test practice online, these resources can also be helpful.

Reword the question

The NCLEX-RN is testing your understanding. Take a moment to be certain you understand exactly what is being asked.

Eliminate wrong answers

Go through the responses and discard any that you know are obviously wrong. This will help you focus on examining the remaining responses for the best possible answer. And remember, sometimes NCLEX is asking which answer is BEST, meaning there may be some truth to all answers.

Is there anything else I should focus on?

The concept of integrated processes underlies the whole exam. These processes are the building blocks of the nursing practice. They will be an essential part of each exam item.

The following five processes make up this underlying exam philosophy:

Nursing process

The nursing process is: assessment, diagnosis, planning, implementation and evaluation (ADPIE).

Caring

Nurses demonstrate respect and concern for clients in order to build a collaborative and trusting environment.

Communication and documentation

Clear, open communication between the client, the client's family, and caregivers is an essential part of the nursing process. Nurses must keep accurate medical records that precisely reflect treatment even during stressful or confusing situations.

Teaching/Learning

Nurses are expected to continue learning throughout their careers, as well as educate their clientsand their families.

Culture and spirituality

Effective nursing considers the beliefs, identity, and uniqueness of each individual being cared for.

How long is the NCLEX-RN?

The test is long, and part of preparing for it will include working on the mental endurance that it takes to focus for hours at a time.

The test itself ranges between a minimum of 75 questions and maximum of 265. There’s no way to predict which number your test will encompass, so don’t read too much into getting the minimum or maximum number. Do be prepared for the test to take between four to six hours to complete. The test will automatically end at its maximum time of six hours, so it won’t go longer than that.

What is the NCLEX-RN exam structure?

There are four major categories and eight subcategories on the exam. The categories all fit under the framework entitled, “Meeting Client Needs” and rely on the nursing process you learned in nursing school: assessment, diagnosis, planning, implementation, and evaluation. All questions fit under one of the four main categories. Let’s take a closer look at these.

Category 1 - Safe and Effective Care Management

This category includes two subcategories:

Management of Care

This subcategory includes activities that improve client care and decrease the amount of medical services needed through treatment coordination. This helps reduce duplication of treatment, therefore improving client outcome and managing costs. Some important aspects of management of care include understanding advance directives, case management, and client rights. Other practices include ethical practices and demonstrated knowledge of legal responsibilities, confidentiality, and continuity of care.

Safety and Infection Control

Safety of nursing staff as well as clients will also be tested on the exam. This includes being able to demonstrate the ability to prevent the spread of pathogens, understanding of standard safety procedures, and accident prevention. Other activities that may appear on the test are the disposition of hazardous waste materials and surgical precautions.

Category 2 - Health Promotion and Maintenance

The second main category of the exam is Health Promotion and Maintenance. This category examines the different health and medical needs of a person at all different stages of life. From newborn care, early childhood development, adolescence, and adulthood, humans encounter various health issues. The skilled RN will understand the medical needs of each stage in the aging process. Activities tested in the Health Promotion and Maintenance category include newborn care through geriatric treatments and all developmental stages in between.

Category 3 - Psychosocial Integrity

This category includes processes by which a nurse cares for not only the physical, but also the mental, emotional, and social wellness of the people in their care. These processes include assessments of potential abuse or neglect, end-of-life care, support through grief or loss, and education on coping skills and aftercare. These skills are especially important for clients experiencing mental health crises or dealing with the aftermath of traumatic injuries. Nursing demands and understanding of how to interpret family dynamics and apply understanding of various cultures.

Category 4 - Physiological Integrity

The Physiological Integrity category is broken down into four subcategories:

Basic care and comfort

Clients often need assistive devices, to learn new ways of doing things, or will need assistance with basic functions that they’ve been performing their whole lives. New issues around mobility, elimination, and personal hygiene will be met by nurses.

Pharmacological and parenteral therapies

Nurses administer medications as well as educate clients on how to self-administer. They will also evaluate the effectiveness and side effects of treatment and monitor for adverse effects. Other processes include identifying appropriate veins for intravenous medication, preparing dosages, and preparing clients for intravenous catheter insertion.

Reduction of risk potential

This process is critical for ensuring clients do not develop life-threatening complications related to medical treatment. The subcategory will include items around reading laboratory reports and interpreting values, understanding diagnostic tests, and monitoring vital signs. Other important aspects include identifying possible complications and being able to respond to them.

Physiological adaptation

This aspect of meeting client needs revolves around providing care for clients with acute, chronic, or life-threatening medical issues. This complex subject includes dealing with alterations in body processes, dealing with health emergencies, responding to unexpected outcomes, and managing clients’ hemodynamics.

What is the question distribution?

Since each exam is different, the content distribution will also vary. The questions will generally fall under the following ranges:

1. Safe and Effective Care Management

Management of Care (17–23%)

Safety and Infection Control (9–15%)

1. Health Promotion and Maintenance (6–12%)

1. Psychosocial Integrity (6–12%)

1. Physiological Integrity

Basic Care and Comfort (6–12%)

Pharmacological and Parenteral Therapies (12–18%)

Reduction of Risk Potential (9–15%)

Physiological Adaptation (11–17%)

What types of questions are on the NCLEX-RN?

A large proportion of the test is multiple choice, but there are other question formats as well. Be prepared for multiple response items, fill-in-the-blanks, audio or visual questions, chart/exhibit questions, hotspot questions, and ordered response questions. Refer to the NCLEX-RN Test Plan for more information on question types.

What should I expect on NCLEX-RN test day?

Well, expect some nerves. If you’re not feeling nervous, great! If you are, it’s totally normal—this test is a big step in your career. Try to get up early and, if you can, skip caffeine in the morning, as this can often add to your jitters. Eat a good breakfast.

Get to your testing site early in order to check in. This process does include providing biometrics like your signature, photo, and a palm vein scan.

The NCSBN has strict rules for exam candidates around confidentiality and more. Make sure you review what you can and cannot bring, and all other guidelines provided by the board. You’re allowed to bring some personal items that you must leave in a locker outside of the testing room. You’ll be able to access some things during your breaks, but remember that you cannot access any cell phones or other devices or any test prep material.

How is the NCLEX-RN test scored?

There are three different scenarios by which a candidate may pass the test, and four failing scenarios.

Scenario 1 - 95% Confidence Interval

This is the most common completion scenario for NCLEX test takers. In this scenario, the computer will end the exam when it has reached 95% certainty that the student’s ability is above or below the passing standard. At that point, the exam will conclude.

Scenario 2 - Maximum-Length

If your ability comes very close to the passing standard without the computer attaining the 95% certainty, the test will continue being administered until the maximum number of questions have been answered. At the conclusion of the exam, the computer will determine whether the candidate has reached the passing standard or not. The pass or fail result will be determined on that result.

Scenario 3 - Running out of time

The NCLEX-RN’s third scenario is called ROOT, or the run-out-of-time rule. This scenario kicks in when the test reaches the end of the allotted six hours and the test taker has not responded to the maximum number of questions. At this point, a few things are examined by the computer. If the student has not answered the minimum number of questions, the result is a fail. If the minimum threshold has been reached, the computer uses the last 60 questions to determine whether the passing standard has been reached or not. If yes, you pass! If no, sadly it is a failed result.

What happens if I don’t pass the NCLEX-RN?

If you don’t pass the exam on the first try, don’t panic: you wouldn’t be the first, and you can always retake the exam. You will receive a Candidate Performance Report (CPR) from the NCSBN that shows how you performed on each section of the exam. This individualized report is a helpful guide in the case of those who opt to retake the exam.

If you don’t pass, take some time to figure out what you want to do next. If you decide to retake the test, study your CPR and focus on the areas where you didn’t perform well. If at first you don’t succeed, try again. And don’t be too hard on yourself—the NCLEX-RN is a huge challenge and working hard at it will make your ultimate success all the sweeter.

NCLEX-RN: Last things to consider

Graduating from nursing school is a feat unto itself. However, the nursing profession is one of the most important parts of integrated, effective, life-saving healthcare. The NCLEX-RN helps our health care system ensure that patients will receive first-class care. Becoming an RN is a worthy goal, especially during these uncertain pandemic times. Good luck on the exam and embarking on this special calling!