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Introduction
NCLEX (National Council Licensure Examination) is a nationwide examination for the licensing of nurses in the United States and Canada since 1994 and 2015, respectively. There are two types, the NCLEX-RN and the NCLEX-PN. After graduation from a school of nursing, one takes the NCLEX exam to receive his or her nursing license. A nursing license gives an individual the permission to practice nursing, granted by the state where he or she met the requirements.
NCLEX examinations are developed and owned by the National Council of State Boards of Nursing, Inc. (NCSBN). The NCSBN administers these examinations on behalf of its member boards which consist of the boards of nursing in the 50 states, the District of Columbia, and four U.S. territories, American Samoa, Guam, Northern Mariana Islands and the Virgin Islands.
To ensure public protection, each board of nursing requires a candidate for licensure to pass the appropriate NCLEX examination, NCLEX-RN for registered nurses and the NCLEX-PN for vocational or practical nurses. NCLEX examinations are designed to test the knowledge, skills and abilities essential for the safe and effective practice of nursing at the entry-level.
NCLEX examinations are provided in a computerized adaptive testing (CAT) format and are presently administered by Pearson VUE in their network of Pearson Professional Centers (PPC). The NCLEX is a type of exam called a criterion-referenced examination. According to the chapter, “NCLEX: What You Need to Know,” in the textbook Nursing Now, a criterion-referenced examination is a “test that compares an individual’s knowledge to a predetermined standard rather than to the performance of others who take the same test.” With computerized exams such as this, the computer selects which question you are asked based on how you answered the previous question. The NCLEX covers a wide range of material. The individual will be scored by their ability to think critically about decisions involving nursing care.
The governing body responsible for making changes to the NCLEX is the National Council of State Boards of Nursing, the NCSBN. They make changes by analyzing the current nursing practices. They do this by surveying approximately 12,000 recently licensed nurses about different nursing activities which appear on the NCLEX. The NCSBN analyzes these nursing activities based on how frequent the activity may occur, how it could impact the client’s safety, and the location of these activities. The NCSBN conducts these analyses every three years, then makes any needed changes to the exam. Changes were made in 2013 and are expected every three years after that date.
In 2015, NCLEX was adopted in Canada, with changes made to address measuring units, drug names, and other terminology differences between the United States and Canada. Additionally, translated NCLEX in Canadian French are offered to French-speaking Canadians.
Exam Content
The majority of test items are written at the cognition level of application or higher, but the exam may include items at all cognitive levels. Examples of cognitive level are memorization or recall, knowledge, analysis and application.
NCLEX-PN
The exam’s content is based on client needs: Safe Effective Care Environment
- Management of Care and Safety and Infection Control
- Health Promotion and Maintenance
- Psychosocial Integrity
- Basic Care and Comfort
- Pharmacological and Parenteral Therapies
- Reduction of Risk Potential
- Physiological Adaptation
NCLEX-RN
- The exam’s content is based on client needs: 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 Reduction of Risk Potential 9-15%
- Physiological Adaptation 11-17%
Question Types
Most of the questions of the NCLEX exam are worded multiple choice questions. In recent years, however, the NCSBN has added new format questions which do not involve simple multiple choice selection. Examples of the new formats include identifying and selecting a particular area of a drawn body part; selecting multiple correct answers via check boxes; free response mathematical questions usually involving medication calculations; and ordering the steps of a medical or nursing procedure.
Questions on the NCLEX exam are of three different types or levels: Level 1, Level 2, and Level 3. Level 1 questions are the most basic questions and make up less than 10 percent of the total questions. Level 1 questions test the individual’s knowledge and understanding. These questions require the individual to recall specific facts and information. Level 2 questions require an additional level of thinking in order to answer the question. In these types of questions, the individual will be required to know specific information and then use it to interpret or analyze the question. Level 2 questions are analysis and application type questions. Level 3 questions are the most complex type of question on the NCLEX. These questions require the individual to judge, evaluate, and combine information. The individual will have to apply the rules, facts, and processes they know and then make decisions about what is best for the patient’s care based on the situation. What makes level 3 questions difficult is the likely existence of more than one correct answer forcing the individual to decide which answer is the best choice. Level 2 and Level 3 questions make up about 95 percent of the questions on the NCLEX exam. However, it is possible for the exam to have no Level 1 question.
Format
The NCLEX exam is taken on a computer at a Pearson Professional Center. Pearson Professional Centers are testing centers for certifications and licenses all over the world. There are numerous testing centers in each state of the U.S. and centers can be found in 175 countries.[9] The NCLEX exam is at least 90 percent multiple-choice questions. The remaining questions require an individual to fill in the blank, choose all of the correct answers from a list of options, put a number of steps in the correct sequence, or identify a correct area on a picture. Some of these alternative format questions ask information about a chart, graph, or audio clip. The questions can also use pictures as the answer choices instead of words. Each question will appear one at a time on a computer screen. Questions will not be repeated; however, questions based on a similar situation could be asked.
Each individual will take a different form of the exam. Since each question depends on how the previous question is answered, an individual can be given between 75 and 265 questions. Only 60 out of the first 75 questions on the exam will count. The 15 that do not count are “trial” questions, and these will be used on future examinations. The “trial” questions are not identified as such, therefore, it is best to answer every question. If the individual continues to get questions from the same category, it could mean that the NCSBN is testing those types of questions, or it could mean that the individual keeps getting those types of questions incorrect. The computer will continue to randomly generate questions from that category until the individual has met the requirements of the test plan.
Each individual will have a maximum of six hours to complete the exam but there is no minimum time limit. There is a mandatory 10-minute break about 2 ½ hours after the start of the exam and another optional break after about 4 hours of testing. It is acceptable to take breaks any time during the exam, however, test-takers will lose the additional break time from the total test time.
A certain number of correctly answered questions is not required to pass the exam. An individual’s score will not be compared to other scores to determine if he or she passes. The NCLEX is graded by comparing the responses to a pre-established standard. Those individuals who meet or exceed the standard pass the exam, those who do not fail.
Not Passing the NCLEX Test – What Happens Next?
If you fail the test, your state board of nursing will mail you a diagnostic profile that will outline both the areas of knowledge in which your performance was satisfactory and the areas in which it was not.
You may retake the test as many times as you need to. The National Council’s policy dictates that you wait at least 91 days before retaking the test. Individual state boards may impose other, stricter requirements.
