NCLEX Test Preparation Study Guide

Preparing to pass the the National Council Licensure Examination (NCLEX) shouldn't be your only goal as a nursing student, but it should be a top priority. Earning an associate's degree in nursing or BSN isn't enough to begin working as a nurse. In just about every state, prospective nurses are required to pass the NCLEX in order to receive licensure.

Why is the NCLEX so important? We'll, for starters, as we already mentioned, you can't become a nurse without taking it. However, just as important, the NCLEX is designed to protect the public by establishing standards for professional practice and ensuring that all nurses can demonstrate entry-level nursing competence. In short, by passing the NCLEX you demonstrate you have the knowledge, skills and critical thinking to perform your duties as a nurse.

The NCLEX will require you to analyze and apply the knowledge you obtain in nursing school. You'll not only be tested on how much you know, but on how well you're able to apply the knowledge and use critical thinking skills to make decisions relating to common nursing and patient care situations.

Below we'll explore what to expect on the NCLEX, the best study tips, and how preparing early in your education will help you master the skills required to pass the NCLEX after graduation.

Key Sections of the NCLEX Exam
The organization of NCLEX is based on a framework of "Meeting Client Needs." Having a basic understanding of the structure of the NCLEX will help you as you begin preparing to pass the exam. It is divided into the following four categories and six subcategories.

  • Safe and Effective Care Environment
    1. Management of Care: 13–19% of questions
    2. Safety and Infection Control: 8–14% of questions
  • Health Promotion and Maintenance: 6–12% of questions
  • Psychosocial Integrity: 6–12% of questions
  • Physiological Integrity
    1. Basic Care and Comfort: 6–12% of questions
    2. Pharmacological and Parenteral Therapies: 13–19% of questions
    3. Reduction of Risk Potential: 13–19% of questions
    4. Physiological Adaptation: 11–17% of questions

What to Expect on the NCLEX
The NCLEX is a computer-based exam that is both interactive and adaptive. Each answer you provide will determine the next question you are asked to answer. Each time you answer a question correctly, you'll be given a higher-level question. Conversely, answer a question incorrectly and you'll be given a slightly lower-level question. You will continue to answer questions until you either pass or fail. The NCLEX may have as few as 75 questions or as many as 265 questions. How many questions you're given will depend on the number of questions you answer correctly.

The NCLEX is a timed test. The maximum allowed time for completion is six hours. The NCLEX is made up of fill-in-the-blank, multiple response, drag-and-drop, graphics-based and multiple-choice questions. The vast majority of the questions found on the NCLEX are multiple-choice, with four possible answers for each question. On the exam you'll be required to interpret tables, charts, graphs and pictures.

You are not allowed to take anything in to the testing center with you. You'll be provided an erasable board for taking notes and an on-screen calculator for making calculations.

Exam Grading
The NCLEX does not provide test takers with a numberic score. You simply receive a pass/fail grade. To pass the NCLEX you must demonstrate competency by answering a minimum number of questions correctly. How many questions you answer will depend on the level of questions asked and how many incorrect responses you provide. Even though your pass/fail grade will be determined at the end of the exam, you will be informed of your grade by the State Board of Nursing about two to four weeks after taking the exam.

If you do not pass the NCLEX, you may re-take the test within 45 days from the date of your first test. You will also be provided a diagnostic report detailing your performance on the exam. This report can be a useful guide as you prepare to take the exam a second time.

Study Tips and Strategies for Passing the NCLEX
The following are the top 20 tips and strategies for improving performance on the NCLEX. If you will take the time to thoroughly research and implement each of the strategies below you will greatly improve your ability to pass the NCLEX.

  • Develop study habits that mirror your learning style.
    Nursing school may not be medical school, but it's challenging nonetheless. Developing effective study habits early on will go a long way to helping you succeed in your nursing studies and prepare for the NCLEX. Develop study habits and methods that mirror your personal learning style and employ the most effective study methods.

  • Start preparing early.
    A lot of nursing students wait until after they graduate to start preparing for the NCLEX. We recommend you orient your study throughout nursing school toward the NCLEX. If you orient your study during nursing school toward preparing for the NCLEX, all you'll need to do when exam time comes is simly review what you've already learned.

  • Review your exams.
    Believe it our not, your term exams can help you prepare for the NCLEX. More and more nursing schools are employing NCLEX style exam questions designed to test both your knowledge and critical thinking skills. Take the opportunity after each exam to review any problems you missed. You can review your exam with your professor or with a study group. Understanding the rationale for all exam questions will help prepare you for the NCLEX.

  • Review, don't study.
    If you've studied hard during nursing school, reviewed your exams, and oriented your study toward preparing for the NCLEX, you don't need to start studying all over again come exam time. Spend several weeks prior to taking the NCLEX refreshing your mind so that you can remember everything you've already learned and spend time completing practice exam questions.

  • Focus on practice questions early.
    Some students start reviewing practice questions a few weeks before taking the NCLEX. We recommend doing content reviews and practice questions simultaneously early on in preparation for the NCLEX. Purchase a good NCLEX review book to assist you in this endeavor. Completing practice questions will improve both your test taking skills and knowledge.

  • Read the rationales.
    Reading the rationales for each practice question is very important. Even if you get a practice question correct, read the rationale anyway. It's very important to understand why the other three choices were not the best choices. Reading all the rationales will better prepare you to pass the NCLEX.

  • Make a list.
    As you review and prepare to take the NCLEX, whenever you come across a word, procedure, condition, disease, or medication that you don't recognize or understand, write it down. At the end of each day, look up each item on your list and review it. These things can and do show up on NCLEX exams.

  • Understand the components of the multipe choice question.
    Multiple choice questions on the NCLEX are easier to analyze once you understand the different parts of the question. The "stem" is the question itself. The other parts include the "case", the patient's situation, and distractors (choices that are incorrect or not the best answer.) Read the stem at least twice to make sure you understand what exactly the question is seeking. And remember, the question always provides all the information you need to identify the correct answer.

  • Don't read more into questions than is there.
    Base all your analysis on information found in the question. Don't make assumptions about information that is not provided. Basing you answer on assumptions often leads to selectin an incorrect response. Stay focus on what the question is asking and the information it provides.

  • Select the best answer.
    On the NCLEX, the best answer is the correct answer. Your job is to determine which of the four answers given is the best answer. For some questions, all four answers may be correct, but only one answer choice is best. Sometimes the easiest way to determine which answer is best is to eliminate "distractor" questions – choices that are actually wrong or do not provide the best answer. (Process of elimination.)

  • Identify the central person.
    The central person in a question is the patient, client or person who is the direct recipient of the nursing care. Other people, including children, spouses, friends and family may be included in the question as a distration. Your answer choice should always focus on the central person in the question.

  • Identify keywords.
    Typically, there is one keyword, or keyword phrase, in the stem that bears the most weight. It may related to a problem being identified, an aspect of the problem, or a patient. Identifying the keyword will help you identify what exactly the question is looking for.

  • Look for repeat words.
    Sometimes the same words appear in both the question and the correct answer. Or you may find a synonym of a word in an answer choice. Identifying repeat words, or a synonym of the word, can help you identify the correct answer.

  • Look for false words.
    The use of a false word will indicate that a wrong nursing action is the correct choice. In this scenario, the question is focusing on what the nurse should not do. False words include except, least likely, contraindicated, need for further education, never, not, violates, etc.

  • Look for opposite answers.
    If two answers choices are opposites of one another, one of the two choices is usually the correct answer.

  • Look for odd answers.
    If there is one answer choice that is substantially different than the other choices, it may be a sign that it is the correct answer.

  • Eliminate answers that are obviously incorrect.
    Multiple answers that offer the same idea or concept are incorrect. Absolute answers that include words such as never, none, always, every, must, just, not and all are usually incorrect. Answer choices that are not related to the question being asked are incorrect. The more question choices you can eliminate, the better your chances of identifying the correct answer.

  • Employ prioritization techniques
    When NCLEX questions use the words initial, first, or best, it's likely all the answer choices are correct, but there will only be one answer choices is the best. In order to identify the best answer among several correct answers, you have to prioritize. When prioritizing, remember ABC's (airway, breathing and circulation), Maslow's hierarchy of needs (physiologic needs before safe, security and psychosocial needs), and the Nursing process (Assess, Diagnose, Plan, Intervention, and Evaluation.)

  • Look for answers with inappropriately client focused care.
    Care should always be focused around the physical and emotional needs of the client. Answers that do not focus on the physical and emotional needs of the client, do not focus on what important to the patient, or do not validate a client's concerns are usually incorrect.

Recommended Study Resources
The following are additional study resources that will help you in your nursing studies as you prepare to take the NCLEX exam.

NCLEX Online Text Prep Resources
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