What is the NCLEX? Everything You Need to Know & How to Prepare

The National Council Licensure Examination (NCLEX) is an exam used to determine if recently graduated nursing students are safe to practice.

Aspiring nurses are required to pass the NCLEX-RN to earn licensure and legally practice nursing in the United States.

There are 2 NCLEX tests: the NCLEX-RN for registered nurses and the NCLEX-PN for licensed practical nurses/licensed vocational nurses.

Both the NCLEX-RN and NCLEX-PN test critical thinking skills using information students learned in nursing school. 

The goal of the NCLEX is to ensure that graduates can make quality nursing judgments and provide safe patient care. 

If you're preparing to take the NCLEX, or will need to at some point, keep reading for everything you need to know about this important exam including what's on it, how to pass, what happens if you don't pass, and more.

NCLEX-RN candidates must have graduated from an accredited ADN or BSN program, and NCLEX-PN candidates must have graduated from an accredited LVN program.

To be eligible to take an NCLEX-RN exam, candidates must have graduated from a program accredited by one of the following two bodies:

1. The Accreditation Commission for Education in Nursing (ACEN)
2. The Commission on Collegiate Nursing Education (CCNE)

Accreditation is also essential if you decide to go back to school to advance your nursing education later. Acceptance into a higher-level nursing program requires a degree or certificate from an accredited program.

There is a two-step process to register for the NCLEX:

1. 1. First, submit an application for licensure and registration to the nursing regulatory body (NRB) where you want to practice.

2. 2. Second, register for the NCLEX through Pearson VUE and pay the exam fee.

You may register online or over the phone (although it is much quicker to do so online). 

There is a 365-day time limit for your NCLEX registration. If the NRB denies you eligibility, you forfeit your exam fee and NCLEX registration. However, you can re-register again at a later date.

>> Related: What Is the Pearson VUE NCLEX Trick?

The Next Generation NCLEX (NGN)

On April 1st, 2023, the National Council of State Boards of Nursing (NCSBN) launched the Next Generation NCLEX (NGN). 

The NGN is the latest version of the NCLEX exam, designed to measure the competencies required of entry-level nurses in a rapidly changing healthcare landscape. 

With new ways to ask questions and a more comprehensive assessment framework, the NGN aims to provide a more accurate representation of a candidate's ability to make complex decisions while caring for patients. 

The NGN Test Plans

The NCBSN puts out test plans that nurses preparing to take the NCLEX can review to get more detailed information about content areas they need to know about. 

Clinical Judgment Model Framework

The NGN exam uses a new framework called the Clinical Judgment Model (CJM) to evaluate a nursing candidate's ability to make sound clinical judgments and decisions in patient care.

The CJM has several layers, and they all interact with the others:

• Layer 0: The test-taker determines the patient's needs

• Layer 1: Encompasses the process of clinical judgment

• Layer 2: If the correct answer is given, the test-taker moves on. If not, they repeat the layers until they get the right outcome.

• Layer 3: Involves cognitive aspects of clinical decision making

  • Form hypothesis: recognizes and analysis cues

  • Refine hypotheses: create solutions

  • Evaluation: take action and evaluate

• Layer 4: Provides external and internal  context for the layers in layers 1 and 2

• The nursing process

  • Assessment

  • Analysis

  • Planning

  • Implementation

  • Evaluation

These components are designed to evaluate the test taker's ability to recognize contextual factors, analyze patient data, prioritize patient needs, and exhibit professional behavior.

Source: NCSBN

The NGN also has some new question formats. Test takers should be prepared for a variety of types of test questions, including:

• Multiple choice questions

• Matrix multiple-choice questions

  • A group of multiple-choice questions is displayed in a grid of rows or columns

• Multiple response questions “Select N”

  • The test-taker cannot select more than the ‘N’ options specified

• Drop-down cloze questions

  • Test-taker selects the answer from a response drop-down menu

• Drop-down table

  • Similar to a drop-down cloze, however, the test-taker  chooses a drop-down element from a table (not a sentence or passage)

• Bowtie questions

  • These have a max score of five points (there are five potential correct answers)

• Multiple responses (MR) Select all the apply (SATA) questions

• Matric MR: +/- Scoring

  • Multi-category questions in rows and columns

• Rational scoring questions

  • Items assessing “paired” information

Learning how to answer Next Gen NCLEX questions can help you manage your time while taking the exam. Understand how to answer NCLEX drop-down questions, NCLEX highlight questions, and other question formats ahead of your test date.

The NGN utilizes different scoring techniques and question-asking methods; however, the subject areas are very similar to the prior version of the NLCEX. 

The NGN test plan is structured around four primary “client needs” categories. 

Here are the NCLEX subject categories with the percentages of each to expect on the exam:

• Effective and safe care environment

  • Care management (15-21%)

  • Infection control and safety (10-16%)

• Health promotion and maintenance (6-12%)

• Psychosocial integrity (6-12%)

• Physiology integrity

  • Primary care and comfort (6-12%)

  • Pharmacological and parenteral therapies (13-19%)

  • Reduction of risk potential (9-15%)

  • Physiological adaptation (11-17%)

Exam takers have up to five hours to complete NCLEX-RN and NCLEX-PN. However, candidates may complete the test in a shorter time frame depending on how quickly they answer questions and how many correct or incorrect answers they have. 

The new NGN It is essential to take your time to answer as accurately as you can because once you submit an answer, you cannot go back and change it.

Computer Adaptive Testing (CAT)

The NGN exam still uses Computer Adaptive Testing (CAT), which means that for every answer you give, the computer estimates your ability based on:

• Your previous answers

• The difficulty of the question

The CAT then determines what our next question should be. The goal is to give you a 50% chance of answering correctly.  The CAT aims to get as much information about your nursing level as possible. As you answer more questions, the program can estimate your nursing ability more accurately.

It is a good idea to start preparing for the NCLEX during your nursing program. Here are a few tips for success:

• Create an NCLEX study plan! Rather than just diving in and hoping for the best, a personalized NCLEX study plan will help you cover all the material without missing anything or having a single cram session.

• Understand how the test works and how much time you have so you are not caught off guard during the exam

• Work in study groups and practice explaining your studies out loud to help you remember

• Understand NCLEX nursing dosage calculations
  

• Take practice exams

• Take study breaks

• Use an NCLEX review course

For the top NCLEX tips from real nurses, check out 11 Tips to Pass the NCLEX the First Time! If you’re looking for more help studying for the NCLEX, take a look at our Top NCLEX Review Courses article. 

If you are seeking to take the Next Gen NCLEX soon, congratulations on nearing the start of a fantastic nursing career! 

What to Do on Exam Day

• On exam day, you will need to bring a valid government-issued ID to verify your identity. 

• You should also plan to arrive at your designated Pearson VUE testing center early and dress comfortably. 

• You will not be allowed to bring any study materials or electronic devices into the testing room.

• The night before your exam, get plenty of rest, so you wake up refreshed and alert.  

• It is a good idea to plan to arrive at your test center at least 30 minutes early to prevent any unexpected delays.

The NGN has three different types of scoring models that are applied to candidate responses:

• 0/1 Scoring: 

  • 1 point for a correct response

  • 0 points for an incorrect response

  • Total score for multi-point items (sum of correct answers)

• +/- Scoring:

  • 1 point for a correct response

  • Subtract 1 point for an incorrect response

  • The total score for a multi-point item is the sum of the incorrect and correct items

  • If there is a negative total score, the score remains 0

• Rational Scoring

  • Test-taker earns points when both “paired” responses are correct

The NCLEX CAT program determines if you passed or failed based on the following rules:

95% Confidence Interval Rule

This rule is the most common. The computer stops giving a candidate questions after it determines with 95% certainty that you have a safe and competent level of knowledge. In this scenario, you have answered enough questions correctly and clearly above a passing nursing knowledge level.

Maximum-Length Exam Rule

At this point, the computer disregards the 95% Confidence Rule. When you are close but not exceeding the passing standard, the computer continues asking more questions and determines whether you pass or fail based on the final ability estimate. If the candidate’s final ability meets or is below the passing standard, they do not pass.

Run Out-of-Time (R.O.O.T) Rule

This happens when a candidate runs out of time before the program can decide whether the candidate passed or failed with 95% certainty. Without answering the minimum number of questions needed, the candidate will have a failing exam.

The NCSBN reports that the 2022 NCLEX pass rates for first-time U.S.-educated nursing students are the following:

• Diploma: 78.31%

• BSN: 82.32%

• ADN: 77.91%

Students can get their “unofficial results” and see if they passed the exam within two business days if their NRB uses the Quick Results Service. 

However, candidates must wait until they receive their final results before they can begin practicing. 

Official results are given through your NRB and take approximately six weeks to be delivered by mail.

>> Related: Lab Values Nursing Students Need to Know for the NCLEX

If you don’t pass the NCLEX, you will get an NCLEX Candidate Performance Report (CPR).

This report will give you more information about how you performed and what you need to work on to pass the exam later. 

If you don’t pass the NCLEX on the first try, don’t fret. You can retake the exam within 45 days from your first test date. Graduates must pass the NCLEX within three years of graduation.

To retake the NCLEX, take the following steps or check out our article on what to do if you did fail the NCLEX:

1. Contact your NRB and tell them you will retake the exam.
2. Re-register to take the NCLEX through Pearson VUE. You will need to pay $200 for the exam and other fees associated with your state’s nursing board.
3. Schedule your next exam date.

>> Related: Watch Nurse Alice's Free Webinar on How to Prepare for the NCLEX, exclusively available in the Nurse.org Nurse Network

• How Long is the NCLEX?

  • Exam takers will stop receiving questions when the program determines they will pass with 95% certainty of competency. The exam can take anywhere from two to five hours. A longer exam may not necessarily mean that the candidate will not pass.

• How Much Does the NCLEX Cost?

  • The cost to take the NCLEX-RN or NCLEX-PN is $200. Each state nursing board also determines additional registration fees. Contact your nursing board for added NCLEX costs in your state.

• What Does NCLEX Stand For?

  • NCLEX stands for National Council Licensure Examination, and it is a test used to determine if recently graduated nursing students are safe to practice.

• How Hard is the NCLEX?

  • The NCSBN reports that the 2022 NCLEX pass rates varied for first-time U.S.-educated nursing students. Diploma-educated students had a 78.31% pass rate, BSN students had an 82.32% pass rate, and ADN-educated students had a 77.91% pass rate.