What is the NCLEX-RN Exam?

  • 11 February, 2022

Whether you're just starting the process of selecting a nursing program or preparing to graduate from your nursing program, you've probably heard of the NCLEX exam. It is common for students to read and research the NCLEX pass rates of a nursing program even before they ever apply. In fact, once you begin your nursing education, the NCLEX will be discussed regularly by your classmates and professors for the entirety of the program! Everything you learn in your nursing program is to prepare you to take and pass the NCLEX so you can achieve your dream of becoming a registered nurse!

What is the NCLEX-RN Exam?

But what exactly is the NCLEX-RN and what do you need to know about it?

NCLEX-RN is the acronym for the National Council Licensure Examination - RN and is the exam required to gain licensure as a registered nurse. There are 2 NCLEX exams - one to become a Practical Nurse (PN) and one to become a registered nurse (RN). Every student who graduates from an accredited Associate Degree Nursing (ADN) program or Bachelor of Science in Nursing (BSN) program becomes eligible for and must pass the NCLEX-RN to qualify for licensure as a RN. Since nursing licenses are issued from individual nursing regulatory bodies or NRBs-known as the state board of nursing for graduates in the US-nursing program graduates must apply for approval from their NRB to take the exam. After approval from your NRB, you become a testing candidate. Graduates from both ADN and BSN programs must not only take the exam but also achieve a passing score to prove they are qualified to practice as a registered nurse.

What Is on the NCLEX-RN?

The NCLEX-RN is designed to test the candidate on a comprehensive range of information that an entry-level nurse is expected to understand. Questions on the NCLEX-RN focus on critical thinking to assess whether you can take the information you have learned throughout the culmination of all your classes and clinical rotations and accurately apply it to a client situation.

The NCLEX-RN exam is not a test for specific nursing specialties, but it does test your ability to meet the needs of clients in all settings through using four categories of major Client Needs established by the NCSBN:

  1. Safe & Effective Care Environment (further divided into Management of Care & Safety and Infection Control)
    • This section includes legal issues (such as privacy, advance directive, informed consent, ethics, Power of Attorney for Health Care, and client rights), as well as case management, client advocacy, delegation, supervision, and prioritization.
    • It also includes accident/error/injury prevention, emergency and security planning, safety, hazardous and infectious materials, precautions, and restraints. 2

  2. Health Promotion & Maintenance
    • Health promotion and maintenance encompasses the development and age-related changes from birth through over age 65 and includes all aspects of pregnancy/delivery/newborn care, developmental stages, health promotion and disease prevention, health screenings, and aging.2)

  3. Psychosocial Integrity
    • The RN is responsible for providing care for the social, mental, and emotional needs of a client.
    • This includes aspects of neglect or abuse, behavioral interventions, crisis intervention, cultural/religious/spiritual awareness, grief and end-of-life care, family dynamics, stress management, and substance use/abuse.2

  4. Physiological Integrity (further divided into Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation)
    • The RN is responsible for the promotion of physical health and wellness of the client which is demonstrated through knowledge of mobility/assistive devices, elimination, comfort, nutrition, hygiene, and rest.
    • Pharmacological and parenteral therapies test the student on medication adverse effects/contraindications/side effects/interactions, blood and blood products, intravenous therapy, medication administration, pain management, and dosage calculation.
    • The RN also has a responsibility to reduce the risk of potential complications or health problems through knowledge of changes/abnormalities in vital signs, laboratory and diagnostic testing, potential for alterations in body system, potential for complications from diagnostic tests/treatments/procedures, and system specific assessments.
    • Managing and providing care for clients with acute, chronic or life-threatening conditions is a large part of the role of the RN and assessed on the NCLEX-RN through questions related to alterations in body systems (including skills to manage the alterations), fluid and electrolyte imbalances, hemodynamics, illness management, medical emergencies, pathophysiology, and unexpected response to therapies. 2

Each of the categories above has a specified percentage of questions assigned (shown in diagram below) so testing candidates will never receive questions that are all from one area.

Distribution of content for nclex rn test plan

2 (https://www.nclex.com/2019_RN_TestPlan-English.pdf)

There are five fundamental nursing processes (referred to as Integrated Processes) that are integrated throughout all the categories of the test:

  1. Nursing Process: - "a scientific, clinical reasoning approach to client care that includes assessment, analysis, planning, implementation and evaluation."
  2. Caring: - "the nurse provides encouragement, hope, support and compassion to help achieve desired outcomes."
  3. Communication and Documentation: - "verbal and nonverbal interactions between the nurse and the client, the client's significant others, and other members of the health care team."
  4. Teaching/Learning: - "facilitation of the acquisition of knowledge, skills and abilities promoting a change in behavior."
  5. Culture and Spirituality: - "interaction of the nurse and the client..which recognizes and considers the client-reported, self-identified, unique and individual preferences to client care, the applicable standard of care and legal considerations." 2

Since the five integrated processes are utilized in meeting all client needs, questions you encounter on the NCLEX-RN will test on both the integrated processes and client needs simultaneously.

What Else Should I Know About the NCLEX-RN?

You will take the NCLEX-RN at a Pearson Professional Center using computerized adaptive testing (CAT). The exam is administered under strict rules which you must agree to on the day of the exam. You will be supervised throughout the entire exam and are not allowed to use any personal materials or devices. When you enter the testing room, you will be given a dry erase board and marker to use for calculations during the exam. There is a calculator available on the computer screen for questions that require calculations. Breaks are allowed during your exam by raising your hand.

During the NCLEX-RN exam, you are expected to use the critical-thinking and problem-solving skills you've been developing to select the correct answer. The exam also helps you to identify "key words" in order to understand what the questions is asking. The questions that include "key words" such as "best, most, essential, first, priority, immediately, highest, initial, next, refute, increased, decreased and support" will have the key word in bold. So, if the question asks what your priority action will be, you will want to select the answer that should be done first. 1

Generic medication names are commonly used, so it is important to know them! There is no set list of medications to know, however. The medications you started learning during your first semester of your nursing program are just as important to know as the ones you may have just learned in your last semester. Units of measurement will be presented in imperial measurement options traditionally used in the nursing field as well as international systems of units (SI) to be familiar to all NCLEX candidates.

The CAT evaluates each answer you provide and adapts to your level of accuracy. You cannot skip questions and cannot go back to previous questions. Random guessing is not advised, since an incorrect answer will determine the ability level of your next question. You may have as few as 75 questions or a maximum of 145 on the NCLEX-RN. Candidates are allowed five hours to complete the test (unless additional testing accommodations have been requested and provided). If, at the completion of your exam, the CAT determines your ability estimate is above the passing standard, you will have passed the NCLEX-RN and will be eligible for licensure by your NRB!

Does This All Sound Overwhelming?

This might seem like a lot of content to cover on one test! But if you're just getting started on your journey to becoming a nurse, just know that each course you take through your nursing program builds on the knowledge you gained in the previous courses to help you develop the knowledge, skills, and abilities necessary to be ready for this test! If you're in your last one-to-two semesters of your nursing program, this is your time to shine-passing the NCLEX-RN exam is one of the reasons you've spent so much time and effort in your nursing program! Overcoming this obstacle is why you've made so many sacrifices and time with your family! The NCLEX-RN allows you to put everything you've learned together to show competency in nursing care. Passing this exam means you are ready to begin your nursing career officially!

To help you prepare for the NCLEX-RN, EduMind can help you review everything you've learned in your nursing program! Learn more about their review courses here: https://www.edumind.com/medical/nclex/.


1 NCLEX FAQs. NCSBN. (2022). Retrieved February 3, 2022, from https://nclex.com/faqs.htm

2 NCSBN NCLEX-RN(®) Examination Test Plan for the National Council Licensure Examination for Registered Nurses. National Council of State Boards of Nursing. (2019). Retrieved February 3, 2022, from https://ncsbn.org/2019_RN_TestPlan-English.pdf

About the Author: Lana Wilkins, MSN, BSN, RN

Lana Wilkins is a Registered Nurse with over 16 years of professional nursing. She is a nursing educator, consultant, Subject Matter Expert, and writer with a passion for helping students and new nurses. She holds a B.S. in Nursing from the University of Oklahoma and a M.S. in Nursing Education from Western Governors University. Outside of the world of nursing she can be found managing the chaos of 2 kids, a husband, and a cat, being crafty, or spending time with friends.

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