An important step in the process of becoming a nurse, the National Council Licensure Exam for Registered Nurses (NCLEX-RN®) measures whether a candidate has the minimum competency required to provide safe and effective nursing care to patients. It’s required for all candidates hoping to become licensed to practice nursing.
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About the Test
The NCLEX-RN is a computer-adaptive test (CAT), which means each question you answer correctly determines the difficulty of the next question, as well as the overall number of questions you will answer. For this reason, there are anywhere between 85 and 150 questions on the NCLEX-RN. There are 15 pretest questions embedded in the total number of questions.
Pretest questions are used to determine the usefulness of such items in future iterations of the exam, which means they are not scored. However, you will not be able to tell the difference between scored questions and unscored pretest questions, so do the best you can on each consecutive question.
Questions will cease once it is determined with 95 percent certainty that you have answered enough questions correctly or incorrectly to fall above or below the standard for passing the exam. The standard for passing the NCLEX-RN is variable and changes every three years. You must perform above the passing standard on the test in order to pass.
NCLEX-RN Exam Outline
There will be somewhere between 85 and 150 questions on the exam. No matter how many questions you answer, the percentage breakdown of questions by content area will be more or less as follows:
- Management of Care: 15%-21% of questions
- Safety and Infection Prevention and Control: 10%-16% of questions
- Health Promotion and Maintenance: 6%-12% of questions
- Psychosocial Integrity: 6%-12% of questions
- Basic Care and Comfort: 6%-12% of questions
- Pharmacological and Parenteral Therapies: 13%-19% of questions
- Reduction of Risk Potential: 9%-15% of questions
- Physiological Adaptation: 11%-17% of questions
You will have up to five hours to complete the entire exam, which includes two optional short breaks. The actual time will depend on the number of questions you need to answer.
It’s important to note that you are not able to skip questions and return to them. You have to answer a question in order to move on to the next one. This means you need to use some of your study time to work on strategies for finding the best possible answer even when you aren’t really sure about the question.
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Top 5 Most Challenging NCLEX® Questions
Now that you know more about the exam, try your hand at some targeted practice!
Over the last year, we’ve compiled the data from about 5,000 test-takers who tried their hand at the practice test at the top of this page. According to the data, around 90% of people answered these five questions incorrectly.
Answer each question and read through the answer explanation, whether you got the answer right or wrong. This will help you ensure you’ve got the topic mastered.
Whether you struggled with these questions or aced them on your first try, be sure to take the full practice test to get a better idea of how prepared you really are!
1. A client is to be discharged with a tracheostomy. Which of the following should the nurse most stress when educating the client about home management? Select all that apply.
2. A physician has prescribed nortriptyline hydrochloride, a tricyclic antidepressant, for a client with postherpetic syndrome who prefers not to take opioids because of a history of substance abuse. When discussing use of the drug with the client, which of the following information should the nurse include? Select all that apply.
3. A client has accidentally splashed a toxic (although not caustic) substance in his right eye, and the nurse must flush the eye. Which of the following steps are correct? Select all that apply.
- Place the client on their right side and elevate their head to 20 degrees.
- Hold the emesis basin against the right side of their face.
- Fill bulb syringe with NS irrigant.
- Hold the right eyelid open with the thumb and index finger.
- Hold the tip of the syringe about a half-inch above the eye and direct the flow of the irrigant toward the lower conjunctival sac, from inner to outer canthus.
- Flush for about 1 minute.
4. The nurse is providing education about Raynaud’s disease to a 35-year-old female client. Which of the following information should the nurse include? Select all that apply.
5. A client has been diagnosed with Parkinson’s disease and has been prescribed levodopa. Which of the following are contraindications to levodopa? Select all that apply.
Registration
Before you can sit for the NCLEX-RN, you’ll need to complete your program’s academic and licensing prerequisites.
You’ll also need to receive an authorization to test. This is given by the Board of Nursing or other regulatory body where you wish to practice nursing. They will determine whether you meet their eligibility criteria to become a licensed nurse.
If you meet the criteria and are given the authorization to test, you can schedule your test at the nearest Pearson VUE testing center. You will have to pay an exam fee of $200, and you will have to choose a date and time within the test-taking window listed on your authorization to test letter.
How the NCLEX-RN is Scored
The NCLEX-RN is scored using a rather unique system. Rather than receiving a point value that reflects either the number of correct answers or the average difficulty level of questions you answered, the score here will be measured in “logits.”
Because the NCLEX-RN exam is computer-adaptive, NCSBN uses a logitⓘ A logit is a unit of measurement that NCSBN uses to report relative differences between test-taker ability estimates and item difficulties. scoring system to determine whether a test-taker passes or fails. In essence, if you receive a logit score of 0.00 or higher, you have answered enough questions correctly and have passed the exam. If you receive a logit score that is lower than 0.00, you have not answered enough questions correctly and have failed the exam.
This logit is being continuously adjusted based on each question you answer which is why there is such a wide range in the number of questions you’ll have to answer on the test. If you reach the minimum 85 questions and the computer program is able to determine with 95% accuracy that you have either passed or failed, the test will end there.
If it is not 95% certain of your results, you will continue to see questions until it is certain or until you reach the maximum of 150 questions. If you reach the maximum, it will do a final assessment to determine if you have met the passing standard.
This might all sound a little complicated but, basically: the better you do, the fewer questions you have to answer. But even if you end up having to answer 150 questions, you might still pass the exam.
If you have met the passing standard, you will simply be informed that you passed the exam. You will only see a detailed report of how you performed on each section of the test if you failed.
Computer-Adaptive Testing
The NCLEX-RN is computer-adaptive, meaning that the test monitors your responses and adapts the questions to match your abilities. Here’s a look at how it works:
Essentially, if you answer a question correctly, you get a more difficult question, but if you are incorrect, you are given an easier question to answer.
How to Study for the NCLEX-RN Exam
Start with an NCLEX Practice Test
Before creating your study schedule, take an NCLEX-RN practice test to establish a starting point. You don’t need to wait until you have reviewed every disease, medication, and nursing procedure. At this stage, the goal is to identify where your preparation time will have the greatest effect.
Review your results according to the following “client needs” categories:
- Safe and Effective Care Environment: Can you prioritize care, delegate tasks appropriately, follow legal and ethical standards, prevent infection, and protect clients from injury?
- Health Promotion and Maintenance: Do you understand growth and development, health screening, prevention, pregnancy, and age-appropriate client education?
- Psychosocial Integrity: Can you recognize mental health concerns, communicate therapeutically, support clients through stressful events, and respond appropriately to behavioral emergencies?
- Physiological Integrity: Do you need more work with basic care, medications and intravenous therapies, preventing complications, or caring for clients with acute and chronic conditions?
- Clinical Judgment: Can you recognize important cues, connect those cues to the client’s condition, prioritize possible explanations, select appropriate interventions, and evaluate the client’s response?
Identifying those specific weaknesses will show you where to devote more attention during your study time.
Review Difficult Questions
After each practice session, review every question you answered incorrectly AND every question you guessed on or answered with low confidence. Guessing correctly does not necessarily mean that you have mastered the skill.
For each difficult question, determine which of the following caused the problem:
- You did not know the underlying condition, medication, procedure, or nursing concept.
- You overlooked an important assessment finding, laboratory result, or change in the client’s condition.
- You recognized the problem but selected an intervention that was not the highest priority.
- You confused what the RN should do with a task that could be delegated.
- You selected an action outside the nurse’s role or scope of practice.
- You chose an intervention without assessing the client first.
- You failed to distinguish an expected finding from a complication requiring immediate attention.
- You misread a negative phrase such as “requires further teaching” or “needs intervention.”
- You struggled to interpret a chart, exhibit, case study, or unfamiliar question format.
- You spent too long debating between answers without identifying the central safety issue.
Then, outline a specific plan for improvement based on what you discovered. In other words, don’t just say, “I need to study pharmacology.” Record that you need to review adverse effects of anticoagulants, safe insulin administration, or which laboratory values should be monitored for a particular medication.
Similarly, replace “practice prioritization” with a more useful goal such as comparing stable and unstable clients, identifying acute changes, or distinguishing immediate safety threats from findings that can be addressed later.
Utilize Answer Explanations
Answer explanations are an underutilized studying resource. To take full advantage of them, read the explanation for every question you found difficult, including questions you answered correctly.
For each one, make sure you can confidently explain:
- Why the correct answer is the safest and most appropriate response
- Why each incorrect option is less appropriate
- What nursing concept or clinical judgment skill is being tested
- Which client information is most important
- How the correct decision would change if the client’s condition or circumstances were different
Don’t stop after reading that one intervention is correct. Determine why it takes priority over the other options. Ask whether the decision is based on immediate safety, an acute change, the nursing process, scope of practice, delegation rules, medication safety, or another principle.
For case-study questions, review the client’s record again and identify which findings were relevant. Separate important cues from background information that did not affect the decision.
Study Nursing Decisions, Not Individual Questions
Memorizing the answer to one NCLEX question will not prepare you for a different client with different symptoms, medications, laboratory results, and risk factors. Your goal should be to understand the nursing knowledge and decision-making process behind the answer.
For example, determine which findings made a particular client unstable and why those findings represented a greater threat than the conditions described in the other options.
Similarly, don’t memorize the steps used to solve one quadratic equation. Make sure you can recognize and solve quadratic equations presented in different forms, including equations, graphs, tables, and word problems.
The exact questions on your test will be different from the ones you encounter during practice. If you can explain a skill without looking at your notes and then apply it correctly to a new question, that is a good indication that you have mastered it.
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NCLEX-RN Online Prep Course
If you want to be fully prepared, Mometrix offers an online NCLEX-RN prep course designed to give you everything you need to succeed!
Here’s what you’ll find in the NCLEX-RN course:
- 140+ Review Lessons Covering Every Topic
- Over 1,900 NCLEX-RN Practice Questions
- 1,000+ Digital Flashcards
- 120+ Instructional Videos
- Money-back Guarantee
- Mobile Access
Everyone learns differently, so we’ve tailored the NCLEX-RN online prep course to ensure every learner has what they need to prepare for the NCLEX-RN exam.
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How to Pass
At this point, you should have a better understanding of the content and structure of the NCLEX-RN. You are undoubtedly ready to begin the process of preparing for the exam. You can help yourself on exam day by getting enough rest, eating properly, and managing your stress. But, the best way to ensure you do well on the NCLEX-RN is to thoroughly prepare.
Mometrix Test Preparation has the test preparation materials you need in the NCLEX Secrets study guide, which gives you real NCLEX-RN content, including expert tips aimed at helping you reduce stress, recall information, and ensure high performance.
In addition to the NCLEX Secrets study guide, Mometrix Test Preparation also offers a comprehensive NCLEX-RN Practice Test, NCLEX Flashcards, and an online NCLEX-RN course!
FAQs
Q
How many questions are on the NCLEX-RN?
A
There are between 85 and 150 questions on the NCLEX-RN.
Q
How long is the NCLEX-RN exam?
A
The NCLEX-RN has a time limit of 5 hours.
Q
What is a passing score on the NCLEX-RN?
A
The passing score for the NCLEX-RN is 0.00 logits.
Q
When will I receive my test scores?
A
You will receive your NCLEX-RN test scores six weeks after completing the exam.
NCLEX and NCLEX-RN are registered trademarks of National Council of State Boards of Nursing, Inc., which is not affiliated with Mometrix Test Preparation and does not endorse this page.
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