If you’re wrapping up nursing school and facing the NCLEX-RN®, you might be intimidated by the career-making (or breaking) exam. The NCLEX-RN® exam tests more than your knowledge of content – it tests your ability to use that knowledge, and apply critical thinking skills when presented with a clinical scenario. This means your questions will require more than regurgitating a memorized list of facts, which is what you’ve seen and been tested on throughout nursing school.
Breaking Down the Exam
The NCLEX-RN® ranges from 75-265 questions depending on how consistently you are able to demonstrate knowledge of content and, more importantly, your ability to integrate your knowledge of content with hypothetical “real-life” situations. The CAT (Computer Adaptive Testing) Technology serves questions of varying difficulty, but this may not mean what you think. “High level of difficulty” does not refer to questions with more obscure content, but to the extent to which critical thinking and analysis are required.
Limited – but Enough – Information
Nurses understand that decisions in healthcare must be made in a timely manner, based on the best information available. Similarly, questions on the NCLEX-RN® exam have a finite amount of information – but the critical information needed to make a decision is always provided. When answering questions on the NCLEX-RN® exam, you may sometimes wish for “more information.” Don’t waste valuable time – everything you need to provide an answer is in the stem and your task is to distill that information, recognize themes and priorities, and avoid pitfalls that could cause harm to the hypothetical client.
Online Practice Questions
The BoardVitals NCLEX-RN® Practice Question Bank offers more than 3,100 practice questions with the same CAT platform found on the exam. These questions are divided into categories so you can assess your strength and weaknesses based on topics. The exam is broken down, as follows, according to the NCLEX-RN® Test Plan:
- 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 Parenteral Therapies 12-18%
- Reduction of Risk Potential 9-15%
- Physiological Adaptation 11-17%
We recommend beginning your NCLEX-RN® prep 3-6 months before the test. Many people find it helpful to begin earlier, by using the question bank to supplement your studies and to help you focus on key points. Practicing test questions will prompt you to integrate the nursing process and critical thinking skills with the content you are mastering.
To become accustomed to the test, we recommend practicing 75 questions each day you can, keeping your time to a reasonable 1-2 minutes. Begin your review of your test by determining your areas of weakness. Study those explanations carefully and refer to other sources if necessary – the referenced books are standard nursing texts, in most cases – but there is a wealth of information online in a variety of formats – video explainers, outlines, concise nursing journal articles, and power point presentations.
When choosing an extra reference for study, be sure it is reputable, preferably reviewed by nurses and academics. There is a lot of incorrect or sloppy information on the internet and it’s worse than a waste of your time. If you decide to use a review book, be sure it is highly rated by your professors or licensed RNs who have recently taken the NCLEX-RN®. If something you read seems unclear or wrong, check the reference provided and compare the information to your nursing texts. There are some topics that are debated, but they most likely won’t be on your test.
Here’s a list of (free) reference sources – for the NCLEX®. Use them as needed to find a quick and reliable explanation, diagram, or flow-chart. As you continue in your career, you will find them helpful to add to your knowledge and to quickly find answers to questions that arise in the course of your work. Since you probably already have your favorite nursing sources, these are limited to non-nursing resources for learning and reference:
- eMedicine – In addition to detailed and clearly written articles about every possible medical condition or procedure, eMedicine has a number of articles on nursing practice. They also have a free drug reference with a lot of good, clearly presented information.
- SAMHSA – Substance Abuse and Mental Health Services Administration
- Orthobullets – For outlines and explanations about orthopedic topics, including procedures and musculoskeletal conditions.
- Life in the Fast Lane – This is a great site for learning ECGs, but also for critical care and emergency practice. It’s maintained by an ER doctor in England and he, with his contributors, provide back to basic explanations for many things you may wonder about.
- Slideshare – Slide presentations by healthcare professionals (among others), including physicians, nurses, respiratory therapists, etc. Just do a search for your topic. Slide presentations are usually concise and also provide visual cues for learning.
- American Academy of Dermatology (AAD) – The AAD has an atlas for skin lesions you may wonder about.
- Centers for Disease Control – The CDC has all the information you need about Standard and Isolation Precautions; important infectious disease; the site has the Pink Book, which contains all the information you will ever need about vaccines, including administration, storage, contraindications, etc.; and the Yellow Book, which tells you all you need to know about travel medicine, including rare but serious diseases like Ebola.
- CDC “Principles of Epidemiology” – This has great explanations of statistical methods and ways of collecting, organizing, and summarizing data; variable types, measures of spread of disease – very useful when thinking about public health topics.
- US Preventive Services Task Force site has detailed recommendations for preventive medicine, including current screening recommendations and the research that supports those recommendations.
- World Health Organization posts numerous health articles that range from Avian Flu to Zika virus, with Palliative Care, Burns, Epidemiology, Statistical Methods and many other topics in between. They also have a number of charts and diagrams.
- OSHA – Of course, there is a wealth of information you may need at OSHA, Department of HHS (CMS, HIPAA, etc.)
- Radiopedia – if you want to learn what community-acquired pneumonia looks like on X-ray compared to pulmonary tuberculosis – a picture is worth 1,000 words, but they also explain the films.
- American Academy of Family Physicians has a great section of educational articles and guidelines available free to non-members. A good place to find out more about a wide variety of conditions.
There are many great sources of reliable information – the ones I’ve listed generally give a brief but comprehensive summary of the information you need – most provide information in two forms – for healthcare professionals and for the general public.
Don’t get stuck on a particular question – the NCLEX-RN® exam doesn’t require a perfect score – about 65% of the questions should be answered correctly to pass, but you do have to answer enough questions correctly to demonstrate your ability to think like a nurse. Sometimes it’s easier to put the troublesome question aside for a couple of days and revisit after the frustration level has diminished. In some cases, you may feel certain an answer is incorrect. We all perceive what we read in light of our own education and experience and there will be some answers based on critical thinking that you may disagree with – read the rationales and if it still doesn’t make sense, let us know and we will try to help you figure it out – or we will correct it, if we’re in error.