Preparing for the NCLEX

nclex-exam computer and stethoscope
After getting your completing a nursing bridge program and earning your degree, the next step is to get your nursing license. To do this, you must apply to take the NCLEX (National Council Licensure Examination) with your state’s board of nursing. The NCLEX is a computerized exam that every nursing student in the United States must pass in order to become a licensed nurse.

If you’re just starting your nursing education, the NCLEX may seem like a long way off, but it is important to take enough time to be sufficiently prepared for it. Here you’ll find answers to some questions you may have, a breakdown of what is covered in this exam, and give you a few quick tips throughout the guide to help you study for the NCLEX.

Questions About the NCLEX

This section will help you learn more about the policies and general structure of the NCLEX. This can give you a better foundation to work with once we go into further detail about what this exam entails, and help you with our quick study tips presented in the guide.

How many questions are on the NCLEX?

You will answer a minimum of 75 questions, but you may also need to answer as many as 265 questions. The NCLEX is a computerized test that is designed to adapt to your answers. Therefore, if you consistently answer the questions correctly, each question will become more difficult than the last. If you get several questions wrong, the difficulty level will either go down or stay the same. Ideally you could pass the test in just 75 questions, but it is okay if the test has you answer more. All it means is that the computer needs more information to assess your nursing knowledge.

How long do I have to take the test?

You have a maximum of six hours to take the test. Some people use the entire six hours, while others don’t. Remember this isn’t a race, and it is okay if you need that time to complete the test. Pro Tip: It’s always a good idea to bring snacks that you can eat during the scheduled breaks in case you get hungry throughout the day.

Where will I be taking the test?

The specific location of the test varies depending on where you live. Each testing center has been approved by the National Council of State Boards of Nursing (NCSBN). Once you have met all of the requirements and have registered for the test, you can schedule an appointment either online or over the phone up to one business day in advance.

I did well on all of my previous nursing exams, so I’m sure I’ll pass the NCLEX, right?

It’s great that you did well on all of your tests and quizzes, but that doesn’t guarantee that you will be able to pass the NCLEX just as easily. The NCLEX is not designed like the exams you take in nursing school. In a nursing program, the point of tests is to make sure you comprehend the material and are ready to move onto the next subject. On the other hand, the NCLEX wants you to flex your critical thinking muscles. You will be required to analyze a variety of scenarios and answer each question by applying what you have learned. The NCLEX is structured in this way so that it can gauge the decisions you will make in real-life nursing situations.

What if I fail? Can I retake the NCLEX?

If you fail, that’s okay! All it means is that now you know what you need to work on for next time, and yes, there can be a next time. The NCSBN will let you retake the NCLEX eight times in one year, as long as there is a 45-day break in between. Some state’s board of nursing/regulatory body (BON/RB) have additional steps that you must complete in order to retake the test, so it is important to contact your state’s BON/RB if you do need to retake it.

When should I start studying for the NCLEX?

It is recommended that you give yourself two-three months of study time prior to your exam date. Remember, this test is going to ask you to apply everything you have learned through your nursing program. After you graduate, the NCLEX is all that stands between you and being a professional registered nurse, so it is imperative that you treat studying for this test like it is your full-time job.

Topics Covered in the NCLEX

All of the topics addressed in the NCLEX are classified as “client needs.” As stated in the NCSBN’s NCLEX-RN 2016 Test Plan, “a client is defined as the individual, family or group, including significant others and population” (p. 1). Most of the information presented in this guide is provided by the NCSBN. There are four main Client Needs categories, and six sub-categories. However, the questions are integrated (not separated by category) in the NCLEX. For example, the first question may present a scenario that falls under “Psychosocial Integrity” and the second question may address a topic under the “Management of Care” category.

The two pictures below show how each category and sub-categories are broken down and what percentage of the exam they take up.

NCLEX Client Needs Chart and Distribution

While it is important to study all of the subjects that are in the NCLEX, you will still need to use your study time wisely. Don’t try to memorize every detail that you’ve been taught, but instead spend a little bit more time focusing on and learning how to apply concepts that you aren’t as comfortable with. Enrolling in a NCLEX-RN prep course and taking practice tests are great ways to learn about the types of questions you may be asked and to get an even better of idea how the test is structured.

Safe and Effective Care Environment

This section breaks down into two subcategories, which are “Management of Care” and “Safety and Infection Control.” Management of Care addresses protecting health care personnel and clients by creating and implementing the most efficient and effective nursing care. Safety and Infection Control is relatively self-explanatory, since it entails protecting clients and professionals from health and environmental hazards.

Management of Care and Safety and Infection Control topics include and are not limited to:

Management of Care Safety & Infection Control
  • Advance Directives/Self-Determination/Life Planning
  • Advocacy
  • Assignment, Delegation & Supervision
  • Case Management
  • Client Rights
  • Confidentiality/Information Security
  • Continuity of Care
  • Establishing Priorities
  • Ethical Practice
  • Informed Consent
  • Legal Rights & Responsibilities
  • Organ Donation
  • Performance Improvement (Quality Improvement)
  • Accident/Error/Injury Prevention
  • Emergency Response Plan
  • Ergonomic Principles
  • Handling Hazardous & Infectious Materials
  • Home Safety
  • Reporting of Incident/Event/Irregular Occurrence/Variance
  • Safe Use of Equipment
  • Security Plan
  • Standard Precautions/Transmission-Based Precautions/Surgical Asepsis
  • Use of Restraints/Safety Devices

When you’re studying for this section, focus on all aspects of that subject. Ask yourself if you know the what, why, when, who, and how of that subject. For instance, you probably know what continuity of care is in the general sense, but do you know why it’s important, when it’s necessary, who is involved, what health concerns can/should be addressed, what options do patients and their caretakers have, how it can be implemented, and is this something that stays the same or does it vary with each patient? These are all great questions to ask yourself about every topic both in this section and all other categories featured in the NCLEX.

Health Promotion and Maintenance

This section has a particularly heavy focus on health as it pertains to each developmental stage, from the proper care of a mother and her baby before birth to the physical and nutritional needs of a geriatric population.

Specifically, the topics in this section include and are not limited to…

  • Aging Process
  • High Risk Behaviors
  • Ante/Intra/Postpartum and Newborn Care
  • Lifestyle Choices
  • Developmental Stages and Transitions
  • Self-Care
  • Health Promotion/Disease Prevention
  • Techniques of Physical Assessment
  • Health Screening

Get creative when studying for this section! You could make, cut out of magazines, or print out paper people at different ages and create a health chart for each of them. Each chart can address the following:

  • What developments are normal during this stage?
  • What common health concerns should nurses and health care professionals look out for?
  • Are there any development and healthcare-need differences between men and women, and what are they?
  • How could risky behaviors or poor lifestyle choices lead to potential health risks?
  • How would you educate patients of different ages on their health needs and what they should avoid?

There are plenty of traditional ways to study for this section too, like flashcards and simply writing down notes from your previous nursing notes and textbooks, but sometimes being creative can help you remember the information a bit better.

Psychosocial Integrity

Unlike the previous subjects, psychosocial deals entirely with mental health and ranges from addiction to grief and loss, from abuse to cultural influences on health, from stress management to behavioral interventions, and so much more. Even if you do not plan on being a registered psychiatric nurse, you will still need to apply many of these concepts on a daily basis. What goes on in a patient and their loved ones’ minds is just as important as any physical ailment.

The most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) can be an especially helpful study aid for this section. This tool can help you further sort out if the symptoms a patient exhibits are the result of mental or physical illness, or if it is a combination of the two. Regardless of the source of any symptoms, it is also part of this section in the NCLEX (and a nurse’s job) to know how and when to communicate and provide a therapeutic environment for both the patient/client and their loved ones.

Physiological Integrity

This section is broken into four subcategories: Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation.

Basic Care & Comfort Pharmacological & Parenteral Therapies Reduction of Risk Potential Physiological Adaptation
  • Assistive Devices
  • Elimination
  • Mobility/Immobility
  • „Non-Pharmacological Comfort Interventions
  • Nutrition & Oral Hydration
  • Personal Hygiene
  • Rest & Sleep
  • Adverse Effects/Contraindications/Side Effects/Interactions
  • Blood and Blood Products
  • Central Venous Access Devices
  • Dosage Calculation
  • Expected Actions/Outcomes
  • Medication Administration
  • Parenteral/Intravenous Therapies
  • Pharmacological Pain Management
  • Total Parenteral Nutrition
  • Changes/Abnormalities in Vital Signs
  • Diagnostic Tests
  • „Laboratory Values
  • Potential for Alterations in Body Systems
  • Potential for Complications of Diagnostic Tests/Treatments/Procedures
  • Potential for Complications from Surgical Procedures and Health Alterations
  • System Specific Assessments
  • Therapeutic Procedures
  • „Alterations in Body Systems
  • Fluid and Electrolyte Imbalances
  • Hemodynamics
  • Illness Management
  • Medical Emergencies
  • Pathophysiology
  • Unexpected Response to Therapies

One way to help you prepare for questions relating to these topics is to find previous case studies. Bloggers and academic medical authors alike have written case studies on a plethora of subjects including medical emergencies, illness management, potential complications, medical dosage calculations and administration, and more. Case studies allow you to see what other professionals did. Take note of how their critical thinking skills allowed them to help the patient. After all, the goal of the NCLEX is to test you on your critical thinking skills to see how you would perform in “real life.” Short of having your own patients/clients, there’s virtually no better way to learn what to do in a tough situation than to discover how professionals before you handled it.

Extra Study Tips

Remember that the NCLEX is not formatted like most of the exams you took during your nursing education. Rather than questions based on memory recall, this exam will present a variety of scenarios.

Sometimes it’s helpful to have a study buddy, and you can ask each other questions based off of practice tests. You could also get creative and come up with your own patient-situation questions and quiz each other. Just be sure that you know the correct answer to your custom question.

Our biggest study tip is that practice makes perfect. Take practice tests, study for those tests using sample questions, and have a study buddy so that you two can quiz each other. Whether you are preparing to take the NCLEX for the first or the eighth time, one of our blog posts, How to Study for the NCLEX exam after Failing the First Time, is sure to help you improve your odds of passing and becoming a registered nurse.

A nursing education and the NCLEX are no picnic, but being able to save countless lives everyday as a nurse is what makes it all worthwhile. Explore the rest of our site to learn more about nursing and how to get started in this amazing career.

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