NCLEX-RN outcomes remain one of the most visible indicators of nursing program effectiveness, academic quality, regulatory confidence, and graduate readiness for entry-level nursing practice. Persistent low first-time pass rates create significant institutional risks, including heightened regulatory scrutiny, accreditation concerns, reputational harm, enrollment instability, and diminished student confidence. Historically, many nursing programs have attempted to improve outcomes through isolated interventions such as standardized testing requirements, remediation mandates, curriculum revisions, or high-stakes progression gates. These approaches may produce temporary improvement but often fail to create sustainable outcomes because NCLEX success is not the result of a single course, assessment, or remediation experience. Rather, NCLEX performance reflects the functioning of an academic ecosystem that includes curriculum design, assessment validity, faculty capability, student support, policy alignment, predictive analytics, and operational processes that support timely testing.

This paper describes the 51cg Comprehensive NCLEX Readiness Model as an integrated, data-driven system designed to improve first-time NCLEX-RN pass rates, reduce time-to-test, strengthen readiness decisions, and support sustainable continuous improvement. The paper then translates the Joyce model into broader evidence-informed strategies that nursing programs can use to improve NCLEX-RN outcomes within accreditation and regulatory expectations. The model is aligned with the Next Generation NCLEX emphasis on clinical judgment, the AACN Essentials competency-based framework, CCNE expectations for licensure outcomes and continuous improvement, and ACEN expectations for outcomes assessment and program effectiveness.

Keywords: NCLEX-RN, Next Generation NCLEX, nursing education, predictive analytics, remediation, curriculum alignment, accreditation, clinical judgment, ATI Comprehensive Predictor, continuous quality improvement

Introduction

NCLEX-RN outcomes are a critical measure of nursing program effectiveness because they represent the point at which academic preparation is externally validated through a national licensure examination. For nursing programs, first-time NCLEX-RN pass rates serve multiple purposes. They are indicators of graduate readiness, markers of program quality, signals to prospective students, and evidence used by boards of nursing and accreditors to assess whether programs are meeting expected outcomes.

The launch of the Next Generation NCLEX on April 1, 2023, increased the importance of clinical judgment preparation across nursing curricula. The NGN was designed to better measure candidates’ clinical judgment and decision-making abilities through innovative item types and case-based measurement approaches (National Council of State Boards of Nursing [NCSBN], 2023a). The NCSBN Clinical Judgment Measurement Model provides a framework for measuring clinical judgment with psychometric rigor and was developed through literature review, expert input, and analysis of data from more than 200,000 NCLEX candidates (NCSBN, 2023b). This shift requires nursing programs to move beyond content coverage and toward intentional development of clinical reasoning, prioritization, cue recognition, hypothesis generation, action planning, and outcome evaluation. The JoyceU Model was reviewed with the 2026 NCLEX (NGN) update. The 2026 NCLEX -RN changes were minimal and did not force consequential changes to the JoyceU Model.

Low NCLEX-RN pass rates are rarely caused by one problem. They often reflect cumulative weaknesses in curriculum sequencing, course rigor, assessment quality, student support, faculty development, academic policies, admissions processes, and post-graduation testing support. Therefore, sustainable improvement requires a systems approach rather than a single intervention. The 51cg Comprehensive NCLEX Readiness Model (JoyceU Model) provides one example of how a nursing program can organize NCLEX improvement as an integrated ecosystem.

The 51cg NCLEX Readiness Model

51cg developed a comprehensive NCLEX readiness system to improve first-time NCLEX pass rates, reduce time-to-test, and ensure consistent and defensible readiness decisions. This work integrated several components of the Diane M. Breckenridge, Zane R. Wolf, and Mary J. Roszkowski (2012) Risk Assessment Profile and Strategies for Success framework. Dr. Johnson introduced the model to 51cg after applying and observing successful implementation at other institutions with historically lower NCLEX performance. Johnson and Rogers adapted and expanded the model for use at 51cg. The model was further tailored to address the specific needs of Joyce students through collaboration with academic leaders, including Dean Jennifer Ayotte, Dr. Becky Collins, Dr. Ashley Otto, Assistant Dean Jennifer Cowherd, Dr. Cory Myers, and Dr. David Haskell. The model is intentionally organized as an integrated ecosystem rather than a collection of isolated initiatives. It includes six interdependent domains: assessment and evaluation, faculty development, NCLEX readiness infrastructure, policy alignment, student support, and curriculum design.

The JoyceU model is grounded in a central premise: NCLEX success is designed, measured, managed, and continuously improved. This differs from traditional approaches that place responsibility primarily on students near the end of the program. In the Joyce model, readiness begins at admission and orientation, continues through course-level assessment and remediation, is reinforced through curriculum and faculty development, and is supported through operational processes that help graduates test promptly.

Assessment and Evaluation

51cg implemented a comprehensive assessment and evaluation model to ensure consistent, valid, NCLEX-aligned measurement of student readiness. The model includes centralized governance, standardized blueprinting, subject matter expert review, AI-assisted item development, unbiased item review, item piloting, and psychometric validation. Exam item piloting was planned to began in Spring 2026, with the goal of developing at least 20 validated new items per exam beginning Fall 2026. The institution also established a key performance indicator to maintain exam failure rates at or below 20% per course beginning Summer 2026.

This assessment strategy recognizes that poor exam quality can distort readiness decisions. If course exams are not psychometrically sound, students may pass courses without demonstrating readiness or fail courses because of flawed items, misaligned content, or inconsistent rigor. Valid assessment systems, therefore, protect students, faculty, programs, and the public. These Joyce-content specific exams were given, along with the standardized, nationally-normed ATI subject-specific Content Master Series examinations in select courses throughout the pre-licensure programs.

Faculty Development

The Joyce model positions faculty development as a core NCLEX readiness intervention. Faculty influence curriculum delivery, classroom rigor, assessment validity, clinical judgment development, remediation quality, and the consistency of student expectations. Joyce strengthened program-specific faculty orientation, developed NCLEX-aligned item-writing and assessment training, prepared faculty for competency-based education, and created a new faculty support and readiness model that includes onboarding, observation, mentoring, and performance monitoring.

Faculty performance data are used to monitor course launch and closure compliance, end-of-course surveys, Content Mastery Series outcomes, predictor performance, and NCLEX pass rates. This approach reframes faculty development as an accountability and improvement system rather than a one-time orientation activity.

NCLEX Readiness Infrastructure

51cg revised its readiness infrastructure by replacing a single high-stakes predictor standard with a multi-indicator readiness model. A revised ATI Comprehensive Predictor benchmark of at least 74% raw average across two attempts replaced the prior single-attempt 95% probability-of-passing requirement. Remediation was required and guided based on each student’s individual learning needs. This change was designed to reduce high-stakes pressure while encouraging sustained preparation and allowing more students who demonstrated readiness to progress.

The ATI RN Comprehensive Predictor is designed to provide a numeric indication of a student’s likelihood of passing the NCLEX-RN and to guide remediation based on missed content (Assessment Technologies Institute [ATI], 2020). ATI’s technical documentation links percent-correct score ranges to predicted probability of passing, including a 74.0% to 74.7% range associated with an estimated 94% to 95% probability of passing the NCLEX-RN (Assessment Technologies Institute, 2020). However, Joyce’s model appropriately uses the predictor as one component of readiness rather than as a stand-alone determinant.

Joyce also incorporated VATI Greenlight requirements, weekly NCLEX data infrastructure, predictive analytics, Pearson VUE voucher incentives, and fast-track transcript processes. These strategies are designed to provide individualized readiness coaching, reduce financial and administrative barriers, and shorten the time between graduation and NCLEX testing.

Policy Alignment

The Joyce model includes systematic policy review because academic policies can either support or undermine readiness. The institution reviewed transfer credit, grading scale, dismissal and appeals, course expiration, assessment expiration, and entrance assessment policies. It also increased the weight of CMS assessments and removed reliance on an in-course exam-average requirement as the sole high-stakes determinant of progression.

The purpose of policy alignment is not to weaken standards. Rather, it is to ensure that standards are valid, equitable, evidence-informed, consistently implemented, and linked to licensure readiness. A defensible readiness system should avoid overreliance on a single high-stakes measure when multiple indicators can provide a more accurate picture of student readiness.

Student Support Systems

Joyce implemented proactive student support systems that identify risk early and intervene before failure occurs. The model includes at-risk dashboards, individualized remediation plans, key concept reviews, ATI CMS-based study plans, learning support services, re-entry safety and success plans, and redesigned new student orientation. Risk indicators include Comprehensive Predictor performance below 74%, CMS performance below benchmark, any single course examination below 80%, and course averages below 77%.

The student support model is designed to shift the institution from reactive remediation to predictive intervention. Rather than waiting until students fail a course or fail the NCLEX, the system identifies risk during the program and deploys targeted supports.

Curriculum Design

Curriculum alignment is central to the Joyce model. The institution strengthened alignment between Joyce-developed curriculum and ATI resources, improved course sequencing, mapped courses to the NCLEX blueprint, AACN Essentials, and program outcomes, and emphasized integrated learning across didactic, lab, simulation, and clinical environments.

This curricular design reflects the NGN emphasis on clinical judgment. Students must not only recall nursing content but also recognize cues, analyze data, prioritize hypotheses, generate solutions, take action, and evaluate outcomes. Therefore, NCLEX improvement requires curriculum structures that repeatedly develop and assess clinical judgment across the program.

Conceptual Figure: The 51cg NCLEX Readiness Ecosystem

Evidence Supporting the JoyceU Model

NGN and Clinical Judgment

The NGN requires programs to prepare students for complex clinical decision-making rather than content recall alone. NCSBN describes the NGN as an exam designed to better measure clinical judgment and decision-making abilities through innovative item types (NCSBN, 2023a). The NCJMM provides a framework for valid measurement of clinical judgment and decision-making within the NCLEX context (NCSBN, 2023b). These developments support Joyce’s emphasis on curriculum alignment, clinical judgment assessment, simulation integration, and progressive complexity across the program.

Predictive Analytics and Multiple Readiness Indicators

The literature supports the use of multiple predictors rather than a single readiness measure. Cummings et al. (2024) found that GPA and the ATI Comprehensive Predictor both accurately classified 86.67% of NCLEX-RN success, while performance in anatomy and physiology and pathophysiology classified 84.81% of NCLEX-RN success. ATI Medical-Surgical scores and the ATI Comprehensive Predictor were also correlated with first-time NCLEX-RN success. These findings support a multi-indicator model that includes academic performance, course-specific standardized assessments, and comprehensive predictors.

The ATI Comprehensive Predictor technical documentation states that the assessment is intended to estimate readiness and guide remediation; it also cautions that institutions using the exam are responsible for decisions based on test scores (Assessment Technologies Institute, 2020). This distinction is important. Standardized predictors can inform readiness decisions, but program leaders should avoid treating them as the only evidence of readiness. Joyce Nursing Leaders track key student performance indicators on a month-over-month basis, comparing performance to past semesters, and then they utilize the data to make real-time adjustments as needed.

Remediation and Student Support

Structured remediation is associated with improved readiness indicators. Meehan and Barker (2021) found that a prescribed remediation protocol helped high-risk students achieve the necessary Comprehensive Predictor scores associated with NCLEX success. House et al. (2021) also reported that a distance-delivered remediation course supported NCLEX-RN success among at-risk students during COVID-19 disruptions. These findings support Joyce’s use of individualized remediation plans, key concept reviews, ATI-guided remediation, and learning support integration.

Assessment Quality and Validity

NCLEX readiness decisions are only as strong as the assessments used to make them. Assessment validity requires alignment between course outcomes, program outcomes, licensure expectations, item design, administration conditions, and score interpretation. ATI’s technical manual emphasizes content validity, reliability, construct considerations, and standardized administration assumptions (Assessment Technologies Institute, 2020). Joyce’s assessment governance model, item piloting, psychometric review, and faculty item-writing development address these validity concerns at the program level.

Systems Thinking and Continuous Quality Improvement

A systems approach is necessary because NCLEX outcomes are influenced by multiple interacting variables.

NOTE:

• Curriculum alignment alone is insufficient if assessment quality is weak.
• Faculty development alone is insufficient if policies create inappropriate progression barriers.
• Remediation alone is insufficient if the risk is identified too late.
• Testing incentives alone are insufficient if students are not academically prepared.

The Joyce model addresses these interdependencies through feedback loops and shared accountability. The Feedback loops are outlined below:

Outcome Metrics and KPI Tables

A comprehensive NCLEX readiness system requires clearly defined outcome measures, operational benchmarks, and continuous performance monitoring processes. Sustainable improvement in first-time NCLEX-RN pass rates cannot be achieved through isolated interventions or retrospective analysis alone. Rather, nursing programs must establish measurable indicators that evaluate readiness longitudinally across the educational continuum.

The following outcome metrics and key performance indicators (KPIs) were developed to support continuous quality improvement, early risk identification, regulatory accountability, and evidence-informed decision-making within the 51cg NCLEX Readiness Model. These metrics intentionally combine leading indicators, such as predictor performance and CMS outcomes, with lagging indicators, such as first-time NCLEX-RN pass rates and time-to-test. This multidimensional approach reflects the understanding that NCLEX success is the product of interconnected academic, operational, instructional, and support systems rather than a single assessment event.

Importantly, these KPIs also support alignment with accreditation and regulatory expectations, including AACN Essentials competency development, CCNE outcomes assessment requirements, ACEN continuous improvement standards, and the Next Generation NCLEX emphasis on clinical judgment readiness. Collectively, these metrics allow institutions to monitor student progression, evaluate intervention effectiveness, identify curricular or assessment concerns, and ensure defensible readiness determinations through systematic and ongoing review processes. Refer to Table 1 below.

Table 1

Core NCLEX Readiness Outcome Metrics

Table 2, below, outlines the key leading, intermediate, operational, lagging, and quality indicators used to monitor and improve NCLEX-RN outcomes within a comprehensive readiness system. Together, these indicators provide a structured framework for continuous quality improvement by allowing institutions to identify risk early, evaluate intervention effectiveness, monitor operational efficiency, and assess long-term licensure outcomes. Leading indicators provide early warning signals that support proactive intervention, while lagging indicators evaluate the ultimate effectiveness of curriculum, instruction, assessment, and support systems. Operational and quality indicators further ensure that institutional processes, assessment validity, and program infrastructure remain aligned with student success and regulatory expectations. Collectively, these measures support evidence-informed decision-making, accountability, and sustainable NCLEX readiness improvement across the program.

Table 2

Leading and Lagging Indicators for NCLEX Improvement

The next table, Table 3, summarizes the major domains within the 51cg NCLEX Readiness Model and translates each domain into actionable strategies that can be adopted by other nursing programs seeking to improve NCLEX-RN outcomes. The framework demonstrates that sustainable licensure success requires coordinated improvement across assessment systems, faculty development, student support, curriculum design, academic policies, and readiness infrastructure. By pairing institutional strategies with transferable program actions, the table provides a practical roadmap for implementing evidence-informed, systems-based approaches to NCLEX readiness and continuous quality improvement.

Table 3

Joyce Model Domains and Program-Level Improvement Actions

Accreditation and Regulatory Implications

CCNE Implications

All 51cg Bachelor’s degree nursing programs are accredited by the Commission on Collegiate Nursing Education (CCNE). The CCNE 2024 Standards require programs to demonstrate achievement of required program outcomes related to licensure. Programs may demonstrate licensure pass-rate achievement through several approaches, including first-time pass rates of 80% or higher for each campus/site and track for the most recent calendar year, all-taker pass rates of 80% or higher, or three-year aggregated approaches (Commission on Collegiate Nursing Education [CCNE], 2024). CCNE also expects programs to provide aggregate student outcome data, including completion rates, licensure pass rates by campus/site and track, certification pass rates where applicable, employment rates, and evidence that data are analyzed and used for ongoing program improvement (CCNE, 2024).

The Joyce model aligns strongly with these expectations because it does not treat NCLEX performance as an isolated annual statistic. Instead, it creates a continuous improvement system in which NCLEX outcomes, assessment analytics, faculty performance, and student success data inform curriculum, policy, and intervention decisions.

ACEN Implications

Our associate’s degree nursing program is accredited by the Accreditation Commission for Education in Nursing (ACEN). ACEN Standard 5 focuses on outcomes and requires nursing programs to demonstrate student learning and program outcome achievement. Although specific benchmarks and reporting structures vary by program type and accreditation context, the underlying expectation is that programs systematically evaluate outcomes, analyze data, and use findings for program improvement. For programs with declining NCLEX outcomes, an integrated model such as Joyce’s provides a stronger accreditation response than a narrow remediation plan because it demonstrates root-cause analysis, shared accountability, data-informed decision-making, and sustained monitoring.

The Joyce model is especially useful from an ACEN lens because it connects NCLEX outcomes to curriculum, faculty, students, policies, and assessment quality. This creates a defensible narrative that the program is not merely reacting to pass-rate concerns but has implemented a structured, measurable, and continuously monitored improvement system.

Board of Nursing and Public Protection Implications

Boards of nursing are concerned not only with pass rates but also with public protection and the readiness of graduates to enter practice safely. A model that strengthens assessment validity, clinical judgment development, remediation, and timely testing supports the public protection function of nursing regulation. The NGN emphasis on clinical judgment further reinforces the need for programs to align learning activities, simulation, clinical experiences, and assessments with entry-level decision-making demands.

Recommendations for Nursing Programs Seeking to Improve NCLEX-RN Outcomes

1. Conduct a Full-System Diagnostic Review

Programs should begin by examining the entire readiness ecosystem rather than assuming the problem is limited to students or a single course. The review should include admissions data, progression data, course outcomes, standardized assessment performance, faculty preparation, curriculum mapping, exam quality, remediation effectiveness, and time-to-test patterns.

2. Build a Multi-Indicator Readiness Model

Programs should avoid overreliance on a single predictor, exit exam, or course grade. A stronger readiness model includes course performance, CMS or specialty assessment performance, comprehensive predictor results, remediation completion, clinical judgment performance, faculty input, and student engagement data.

3. Establish Assessment Governance

Programs should implement standardized blueprinting, item-writing training, item review, exam analysis, and psychometric review. Assessment quality should be monitored as a program-level quality indicator rather than left solely to individual faculty preference.

4. Align Curriculum to NGN Clinical Judgment Expectations

Programs should map curriculum to the NCLEX test plan, NCJMM cognitive operations, AACN Essentials competencies, and program outcomes. Clinical judgment should be developed progressively through didactic learning, unfolding case studies, simulation, lab, clinical, and debriefing.

5. Implement Early Alert Dashboards

Programs should identify risk before course failure or graduation. Dashboards should include academic performance, standardized assessment scores, attendance, progression history, remediation completion, and engagement with support services.

6. Standardize Remediation

Remediation should be structured, individualized, documented, and connected to missed content and clinical judgment deficits. Students should receive clear expectations, targeted resources, faculty follow-up, and accountability checkpoints.

7. Strengthen Faculty Capability

Faculty development should include NCLEX test plan updates, NGN item-writing, clinical judgment pedagogy, exam analysis, remediation coaching, and competency-based education principles. Faculty data should be used to guide support, not merely evaluation.

8. Review Policies for Validity and Equity

Programs should evaluate whether grading, progression, dismissal, transfer credit, re-entry, and standardized testing policies are evidence-informed and consistently implemented. Policies should protect academic standards while avoiding unnecessary barriers that are not predictive of licensure success.

9. Reduce Time-to-Test

Programs should examine operational delays between graduation and NCLEX testing. Transcript processing, ATT support, testing fee barriers, advising, and scheduling assistance should be reviewed and improved.

10. Create a Continuous Improvement Rhythm

NCLEX performance should be reviewed continuously through formal governance structures. Programs should establish monthly and quarterly NCLEX readiness reviews, annual curriculum variance reviews, post-exam assessment reviews, and regular reporting to academic leadership. Annual program reviews are not enough.

Discussion

The 51cg model demonstrates that NCLEX improvement is most defensible when it is framed as academic quality improvement rather than test preparation alone. This distinction matters. Programs that focus only on test preparation may improve short-term performance while leaving deeper curricular, assessment, and faculty issues unresolved. In contrast, programs that build integrated readiness ecosystems can improve NCLEX outcomes while strengthening overall educational quality.

The model also supports equity. Overreliance on a single high-stakes gate can disproportionately harm students when the gate is not sufficiently valid, when remediation is inconsistent, or when operational barriers delay testing. A multi-indicator model allows programs to maintain rigor while ensuring that readiness decisions are based on a fuller body of evidence.

Finally, the model supports accreditation defensibility. Accreditors expect programs to analyze outcomes, identify variances, implement improvements, and evaluate effectiveness. The Joyce ecosystem provides a structure for demonstrating that NCLEX outcomes are actively managed through a formal quality system.

Conclusion

NCLEX-RN outcomes are not isolated student outcomes; they are institutional outcomes produced by curriculum, assessment, faculty, policy, student support, and operational systems. 51cg’s Comprehensive NCLEX Readiness Model offers a practical and evidence-informed example of how nursing programs can improve first-time pass rates through intentional design, predictive analytics, early intervention, assessment governance, faculty development, policy alignment, and continuous feedback loops.

We have had early, clear, and measurable NCLEX_RN pass rate success with initial implementation. We will continue to test and refine this model over the next two years. Programs seeking to improve NCLEX-RN outcomes should move beyond reactive remediation and adopt integrated readiness ecosystems that work for their unique system and student demographics. Such systems are better aligned with the Next Generation NCLEX, competency-based education, accreditation expectations, and the public protection mission of nursing education.

References

American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. Author.
Assessment Technologies Institute. (2020). Technical manual for the RN Comprehensive Predictor 2019. Assessment Technologies Institute.
Breckenridge, D. M., Wolf, Z. R., & Roszkowski, M. J. (2012). Risk assessment profile and strategies for success instrument: Determining prelicensure nursing students’ risk for academic success. Journal of Nursing Education, 51(3), 160–166.
Commission on Collegiate Nursing Education. (2024). Standards for accreditation of baccalaureate and graduate nursing programs. American Association of Colleges of Nursing.
Cummings, J. A. F., Kennard, D., Egan, J., Aryal, S., & McVey, C. (2024). An exploratory study: Indicators of NCLEX-RN success. Teaching and Learning in Nursing.
Giddens, J. F. (2022). The revised AACN Essentials: Implications for nursing regulation. Journal of Nursing Regulation, 13(1), 53–56.
House, S. K., Hubbard, J., & Bacus, R. (2021). Adapting NCLEX-RN remediation during the COVID-19 pandemic. Teaching and Learning in Nursing, 17(1), 74–78.
Lewis, L. S., Willard, V., & Staudt, C. (2023). Effect of a commercial NCLEX-RN preparation product on first-time pass rates. Nursing Reports, 13(3), 1141–1150.
Meehan, C. D., & Barker, N. (2021). Remediation for NCLEX-RN success in high-risk nursing students. Teaching and Learning in Nursing, 16(3), 254–257.
National Council of State Boards of Nursing. (2023a). Next Generation NCLEX.
National Council of State Boards of Nursing. (2023b). Clinical Judgment Measurement Model.
National Council of State Boards of Nursing. (2026). NCLEX pass rates.

Appendix A

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1. Understand the NCLEX Exam

The NCLEX is a standardized assessment overseen by the National Council of State Boards of Nursing (NCSBN). Passing this exam is imperative, as it serves as the gateway for all nurses acquiring their nursing license and enabling them to practice as RNs.

NCLEX Format and Structure

Understanding the anticipated question count on the NCLEX can be a reassuring strategy for managing anxiety. The variable format of the NCLEX features a range of questions, spanning from 75 to 265, instead of one set number that each RN candidate must answer. The point of this format is for great test takers to not have to answer so many questions and for people who struggle with testing to have ample time to demonstrate their knowledge. Test-takers are administered questions until enough information is gathered to determine a pass or fail, all within five hours, including breaks.

Content Categories and Weightage

The NCLEX is structured in four major client needs categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity. Understanding question types, the variable question count, and the weightage of the four client needs categories is vital for effective preparation.

2. Prepare a Study Plan

An effective NCLEX study plan will include timelines and goals for tackling different content areas of the test. Having the right resources is instrumental in preparing for and passing the exam for RN candidates.

• Practice test questions
• Work with a Tutor
• Get together in study groups
• Go back to your textbooks
• Keep your nursing program course notes handy
• Use other commercially available NCLEX-RN prep materials

3. Identify NCLEX-Specific Stressors

Navigating the NCLEX comes with its unique set of stressors, which can significantly impact aspiring nurses. Common sources of stress and anxiety often stem from the high stakes of the exam, as passing is crucial for obtaining an RN license. Addressing performance pressure is essential, ensuring that you approach the NCLEX with confidence and a well-prepared mindset. Some ways to manage this pressure are to visit a mental health professional, learn more about the NCLEX-RN requirements, and to remind yourself you can take the NCLEX-RN more than once if need be.

4. Get to Know NCLEX Test-Taking Strategies

Taking the NCLEX requires not only a comprehensive understanding of nursing knowledge but also a mastery of effective test-taking strategies. As this examination encompasses a variety of questions and  can present a challenging time constraint, having a well-structured approach is essential.

Time Management Techniques

Effective time management is a critical aspect of success when facing the NCLEX. This includes setting time limits for each question, avoiding getting stuck on challenging items, and ensuring that there’s ample time for review. Time management techniques help test-takers maintain a steady pace, ensuring they have the opportunity to address all questions and reduce the risk of rushing through the later sections of the exam.

Dealing with Uncertainty and Guessing

Dealing with uncertainty and guessing can be inevitable on the NCLEX, where not all questions may be answerable with absolute certainty. It’s crucial to avoid getting bogged down on a single question and to make educated guesses when necessary, using hints or clues within the question to make the best-informed choice.

5. Adjust Your Approach Different Types of Questions

Navigating the NCLEX’s diverse question types demands a multifaceted approach to ensure success. Understanding the unique requirements of each question format is key. By tailoring your approach to each question type, you can maximize your performance on the NCLEX and demonstrate your readiness to excel as an RN.

• Multiple-choice: Carefully read the stem and all answer choices before selecting the best response.
• Select All That Apply (SATA): Identify all correct options by considering each choice independently and assessing whether it appropriately answers what the question is asking.
• Prioritization: This requires a keen understanding of client care and the ability to rank interventions effectively.
• Math Calculation: Necessitate precision in solving mathematical problems, keeping in mind rounding instructions and standard conversion rates when applicable.
• Chart/Exhibit-Based: Require the interpretation of a larger amount of data for a thorough response.
• Audio: Involve attentive listening to provide accurate answers.
• Fill-in-the-blank: Follow specific rounding guidelines if provided while entering the correct answer.

6. Prepare Mentally for the NCLEX Exam

Mental preparation for the NCLEX is a crucial aspect of success. Embracing mindfulness and meditation techniques can help calm nerves and improve focus during the test. Visualizations and positive affirmations are powerful tools to boost confidence and alleviate anxiety, enabling candidates to approach the exam with a positive mindset. Incorporating breathing exercises for relaxation can further aid in maintaining composure throughout the testing process. These mental preparation strategies equip aspiring nurses with the inner strength and resilience needed to tackle the NCLEX with confidence and achieve their professional goals.

7. Create a Supportive Environment

Creating a supportive environment is pivotal in ensuring a successful NCLEX journey. Building a robust support system can provide the motivation and encouragement needed to persevere through the challenging preparation period. Open and honest communication with family and friends helps establish a nurturing atmosphere, as they can better understand the demands and offer essential emotional backing. Handling social media and peer comparisons is equally vital. It’s important to avoid getting entangled in the stress-inducing cycle of comparing one’s progress to others. Fostering a supportive environment that prioritizes emotional well-being can significantly enhance one’s ability to stay focused and composed throughout the NCLEX preparation process.

8. Manage Test-Day Anxiety

Managing anxiety is a critical component of NCLEX success. Preparing the night before can significantly reduce stress by ensuring that all necessary materials, identification, and any essential documents are organized and ready. Proper nutrition and staying hydrated on the day of the exam are fundamental to maintaining optimal mental and physical condition, allowing for clear thinking and sustained energy.

Additionally, practicing positive visualization before the exam can help instill a sense of confidence and composure. These strategies collectively contribute to a calm and collected test-day experience, empowering candidates to approach the NCLEX with the utmost readiness and focus. Try to schedule the examination so that you have appropriate time for self-care both before and after the exam. Self-care can go a long way to alleviating stress.

During the NCLEX Exam

Managing your mindset and approach during the NCLEX is necessary for a successful outcome. To avoid panic during the test, it’s essential to stay composed and not let challenging questions disrupt your overall rhythm. Using breaks effectively is crucial for recharging and regaining focus. Taking short, purposeful breaks can help maintain mental sharpness. One ten minute break every 50 minutes has been shown to recharge ones mental acuity and focus. Staying focused and confident throughout the exam is essential. Believe in your preparation and ability to tackle each question, maintaining a positive and resilient mindset.

Post-Exam Coping Strategies

After completing the NCLEX, it’s crucial to employ effective post-exam coping strategies. Debriefing and reflecting on the exam can help you identify areas of improvement and better prepare for future attempts if necessary. However, it’s equally important to avoid post-exam rumination, as excessive dwelling on the test can lead to unnecessary stress. Instead, reward yourself for your efforts and dedication. Celebrate the journey you’ve undertaken, regardless of the exam’s outcome, and acknowledge your hard work.

Coping with NCLEX Results

To cope with NCLEX , begin by understanding the NCLEX scoring system to grasp your performance and identify areas for improvement. Managing expectations and emotions is essential, as your results may not always align with your expectations. Stay resilient and adaptable in the face of varying outcomes. If a retake is necessary, create a well-structured plan to address weaknesses and enhance your chances of success in subsequent attempts. These coping strategies help candidates navigate the challenging terrain of NCLEX results, ensuring they remain focused on their ultimate goal of becoming a registered nurse.

9. Maintain Overall Well-being during NCLEX Preparation

Ensuring overall well-being while preparing for the NCLEX is a paramount concern. Balancing study and self-care is crucial, as it prevents burnout and maintains mental and emotional stability. Physical exercise plays a significant role in stress management, as it releases endorphins and enhances overall resilience. Moreover, the impact of nutrition on managing anxiety should not be underestimated, as a well-balanced diet can provide the necessary energy and focus for effective study sessions. By addressing these aspects, aspiring nurses can optimize their well-being throughout their NCLEX preparation journey, setting the stage for success.

10. Seek Professional Support

Seeking professional support during your NCLEX preparation is a wise step to ensure that you’re equipped to navigate the challenges effectively. Recognizing when you need help is an important first step. Accessing various mental health resources can provide valuable guidance and emotional support during the stressful preparation period. Joining supportive study groups and communities can foster a sense of camaraderie and shared learning experiences, reducing feelings of isolation. These avenues for professional support can significantly enhance your overall readiness and well-being, helping you confidently approach the NCLEX with a robust support network in place.

The journey to becoming a registered nurse, culminating in the NCLEX, is undeniably challenging. It’s not just a test of knowledge but also a test of mental and emotional resilience. To succeed, we’ve explored a range of strategies, from understanding the exam’s format and unique question types to maintaining overall well-being and seeking professional support when needed.

Yet, as you stand on the cusp of this significant milestone, it’s essential to remember that managing stress and anxiety is an integral part of the process. Embrace mindfulness, visualization, and positive affirmations, as well as practicing effective breathing exercises. This can reduce anxiety and bolster your confidence on test day.

As you enter the NCLEX exam room, take a deep breath, trust in your abilities, and recall the reasons that led you to this moment. With mindfulness, visualization, and a positive mindset, you can navigate this challenge with confidence.

Whether you’re beginning your healthcare journey with our ASN program, pursuing a traditional BSN degree or accelerated BSN program, advancing through our RN to BSN program, or reaching higher with an MSN degree, discover which nursing program aligns with your career goals by exploring our nursing school.

As an accredited nursing school, 51cg prepares students with the specialized knowledge and foundations needed to pass the NCLEX and start a career in nursing.

Read on to learn how to create a solid NCLEX study plan, including what to study, how much time it takes to prepare, and how hard you need to study, so you can go into the test with the confidence, ready to become an RN.

What to Study for the NCLEX

In order to know what to study for the NCLEX, it’s important to understand the format of the test. The NCLEX is administered with computerized adaptive testing (CAT), meaning that you will take the exam on a computer.

The test consists of multiple choice and alternate format questions. The variable length of the exam ranges from 75 to 265 questions, instead of one set number that all test-takers must answer. RN candidates will continue to be administered questions until enough information is gathered to determine on a pass or fail. Regardless of the amount of questions asked, students have five hours to complete the exam.

The test is structured into major client needs categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity. An RN candidate will pass or fail the NCLEX depending on three scenarios:

1. The 95% Confidence Interval Rule

The computer stops administering questions when it is 95% certain that the candidate’s ability is either clearly above or below the passing standard.

2. Maximum-Length Exam

The computer continues to administer prompts until it reaches the max 265 questions. If the candidate answers enough correctly, they will pass. If not, they will fail.

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

When the RN candidate runs out of time and has not met the 95% certainty rule, they will fail if they have not answered the minimum required items. Conversely, they will pass if they have answered the minimum required questions and the score is above passing.

Become Familiar with Different Question Formats

The NCLEX contains a variety of question formats to challenge potential RNs and test their skills as they would on the job. Seven types of alternate format questions that can appear in random order when taking the test include:

• Audio
  Listen to an audio clip to answer the question.
• Chart/Exhibit
  Read the chart/exhibit to find the information needed to answer the question.
• Graphic
  Select the appropriate graphic to answer the question.
• Hot Spot
  Identify an area on a photo or graphic.
• Multiple Response
  Select more than one correct answer.
• Ordered Response
  Prioritize or rank option choices accordingly.
• Fill-in-the-Blank
  Reserved for calculations, the answer must be typed into the box provided.

Practice With Common NCLEX Questions

When studying for the NCLEX, practice using NCLEX-style questions to prepare yourself for the test. Utilizing questions in the same style as the NCLEX will help create confidence and reduce test-taking anxiety on test day. Analyzing your answers and rationales will improve your critical thinking skills and increase your ability to retain information.

Common questions for the NCLEX can include diagnosis, people skills, and treatment plans. By familiarizing yourself with the questions asked, you will be completing a crucial part of NCLEX preparation.

Invest in NCLEX Resources and Guides

Having the right resources is instrumental in preparing for and passing the NCLEX for RN candidates. There are free online resources, from practice tests to study guides, to get you ready for the test. Practice tests familiarize you with the exam structure and provide insights into your strengths and weaknesses.

Take NCLEX Prep Courses

Test-takers who struggle to set aside time to study on their own might prefer the format of a prep course. If you learn better in a structured environment, there are options for prep courses both online and in classrooms. A NCLEX prep course adds additional costs, yet for many students, the price is worth it for the assurance that a structured learning environment can bring. Some nursing programs, like those at 51cg, include NCLEX prep as part of the  curriculum offerings, ensuring students are confident and prepared before take the boards exam.

Prep courses also serve as an option for students who didn’t take the test immediately after graduation and need a refresher on the material. A prep course will help you bring the knowledge to the forefront of your mind if it’s been a while since graduation. With a structured prep course, you can save yourself the time you would have spent sorting out study materials and old notes.

Consider How You Should Prepare for the NCLEX

There isn’t a one-size-fits-all approach to preparing for the NCLEX. Factors such as the strength of your nursing school’s NCLEX review courses, graduation rates, and your study habits can affect the length of time you need to prepare.

Test registration is typically available starting six weeks before your program ends. Once you decide you’re ready to test, sign up and pay your exam and licensure fees — around $300.

Developing your NCLEX study guide, reviewing materials consistently, taking practice tests, and practicing mindfulness techniques should all be taken into consideration when planning the length of time needed to prepare for the exam.

Think 51cg How Many Hours You Should Study for the NCLEX

Considering the of the NCLEX, give yourself plenty of time to study to ensure passing the first time you take it. Rather than cramming all of your studying into an impossible timeframe, pace yourself and take care of your mind and body as you’re preparing. Allocate a specific amount of time each day, for at least a month, to study and itemize the topics you need to cover during each session.

Know How Hard You Need to Study for NCLEX

How hard you study for the NCLEX is not about the hours you put in, but how you use them. Nursing students and graduates preparing for the test should be aware that this is not like the tests you took in nursing school, and cramming will not yield the results you want. By avoiding these common mistakes, you will be on a successful path to passing the NCLEX no matter how hard you study.

When studying for the NCLEX, it is important to create an environment similar to the one you will encounter on exam day. Taking practice tests under timed conditions will help you create a test-like environment, identify your weaknesses, and allow you to focus on these categories for further improvement.

Create a Testing Plan

Now that you know what the NCLEX is, how to understand the types of questions that you will be tested on, and how long you will need to set aside to study, it’s time to create a testing plan.

An effective plan will include timelines and goals for tackling different content areas of the test. Studying for the NCLEX with a group of friends can also help ensure your exam success. Exam preparation is hard work, but it can be rewarding and beneficial to study with someone else.

Utilizing resources, time management, and simulating the testing environment are all keys for effective NCLEX preparation. With your NCLEX study plan in place, you will be ready to pass the test and begin a fulfilling career as an RN.

Ready to Start Your Path to NCLEX Success?

Whether you’re beginning your healthcare journey with our ASN program, pursuing a 3 year BSN degree or accelerated BSN program, advancing through our RN to BSN program, or reaching higher with an MSN degree, we’ll prepare you for NCLEX success every step of the way. Start your nursing education at our nursing school today.

Determine Your Eligibility

Before registering for the NCLEX, ensure that you meet the eligibility requirements set by the state board of nursing in the state where you want to practice. These requirements typically include completion of an accredited nursing program and submission of necessary documentation.

Create an Account

Once you’ve determined that you’re eligible to sit for the NCLEX-RN exam, it’s time to create an account on Pearson Vue website. To create an account, you’ll provide your personal information, contact details, and a valid email address. Visit pearsonvue.com/nclex to create an account.

Submit the Application

Log in to your NCSBN account and navigate to the NCLEX registration section. Fill out the application form accurately, providing information about your nursing education, previous licensure (if applicable), and any accommodations you may require for the exam.

Pay the Registration Fee

Once you have completed the application, you will be prompted to pay the NCLEX registration fee. The fee amount may vary year to year, so be sure to check the current fee structure on the NCSBN website prior to registering. Payment options typically include credit or debit cards.

Receive the Authorization to Test (ATT)

After submitting your application and payment, you will receive an Authorization to Test (ATT) via email or through your NCSBN account. The ATT will include important information such as your candidate identification number and instructions for scheduling your exam.

Schedule Your Exam

Using the instructions provided in the ATT, schedule your NCLEX exam with Pearson VUE, the testing vendor for the NCLEX. You can schedule your exam online, over the phone, or through the Pearson VUE website. Choose a suitable testing center location, along with a convenient date and time for your examination. For Utah candidates, they must also request and receive authorization to test from DOPL before they can sit for the exam.

Prepare for the Exam

Once you have scheduled your exam, it’s time to start preparing. Create a study plan, gather relevant study materials and resources, and engage in focused review and practice. Refer to reliable NCLEX study guides, textbooks, online resources, and practice exams to enhance your preparation. Get more tips on How to Study for the NCLEX.

Take the Exam

On the day of your exam, dress comfortably and arrive at least 30 minutes before your scheduled testing time. You’ll be required to provide biometrics to verify your identity. When you’re ready to begin your exam, it’s important to set a pace. You have five hours to complete the test, including breaks, and once you’ve answered a question you cannot go back. So analyze carefully.

Remember to check the specific registration requirements and processes of your state’s nursing regulatory body, as they may have additional or slightly different steps. Following these general steps will help you navigate the NCLEX registration process and take a significant step towards achieving your nursing career goals. Good luck!

Do you have career aspirations in leadership? Our 1-year Master of Science in Nursing program will prepare you to sit for the Certified Nurse Educator (CNE) or Certified Nurse Manager and Leader (CNML) certifications.

That’s where we come in. This guide will equip you with specific strategies to teach you how to break down NCLEX questions, analyze them, and answer them confidently.

Read on to learn how to understand all aspects of an NCLEX question, apply nursing knowledge and theory, and successfully qualify as an RN.

Computerized Adaptive Testing

The NCLEX uses a system known as computerized adaptive testing (CAT) to gauge your abilities. The system will give you questions of variable difficulty, gradually honing in on what level you’re able to answer consistently. The test starts easy and, as you answer questions correctly, gradually increases in difficulty. The NCLEX will ramp up the difficulty until you get a question wrong. When or if that happens, it will then give you some easier questions. If you get those right, the questions will get more difficult.

The test is trying to find the level of difficulty of questions you can consistently answer. If you can keep answering questions at a level above a certain baseline, you pass. If you can’t consistently answer questions at that baseline, you don’t.

Related Resource: How to Manage Stress Before Taking the NCLEX

NCLEX Test Length

One of the most noticeable features of the NCLEX is its variable length. The test is anywhere from 75 to 265 questions long. If the test ends after question 75, that means one of two things: Either it’s decided you’ve gotten so many questions wrong it’s time to terminate the test, or you’ve performed so admirably there’s no need for you to sit and keep proving yourself. A 75-question test is either the very best or very worst a future RN can do, and that leads to no shortage of anxiety for NCLEX test takers.

Regardless of how many questions the test gives you, you’ll have up to six hours to complete it. That includes breaks and a brief tutorial.

Related Resource: Normal Lab Values in Nursing

Experimental Questions

The NCSBN rewrites the entire NCLEX every three years. It takes a lot of testing for new questions to become an official part of the exam, and part of that is live tests on real students such as yourself.

Somewhere in the NCLEX are a few questions that don’t have anything to do with your score. Instead, they’re new types of questions the NCSBN is trying out on you. In these instances, the test isn’t evaluating you; you’re helping evaluate potentially new parts of the test. There’s nothing to distinguish these questions from the others. You won’t know when you’re dealing with a live question that contributes to your score, or when you’re facing one that’s being tried out for future tests. Your only option is to prepare and answer to the best of your abilities.

Related Resource: 8 NCLEX-RN Exam Practice Questions

At 51cg, it’s our mission to foster those abilities. We dedicate entire courses to studying the ins and outs of the NCLEX and the types of questions you’ll encounter. We also give you real examples of how the test adapts and thinks.

At Joyce, we have a lot of experience with helping students pass the NCLEX-RN exam. We’ve found that studying practice questions and familiarizing yourself with the test structure is one of the best ways to prepare for the exam.

The NCLEX-RN is organized into four categories: Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. We’ve organized our NCLEX-RN exam practice questions based on these categorizes, to give you a good idea what will be asked on the test.

Related resource: The Anatomy of the NCLEX

1. Delegation of Assignments (Safe and Effective Care Environment)

According to the National Council of State Boards of Nursing (NCSBN), 26-38% of the questions on the NCLEX-RN are selected from the Safe and Effective Care Environment category. These questions relate to management of care and safety and infection control.

Question:

The nurse can safely assign which task to an unlicensed assistive personnel (UAP) for a patient who is stable after a myocardial infarction?

A. Measure and record intake and output
B. Answer the family’s questions about aftercare
C. Report any unusual lung sounds
D. Teach the patient about a heart-healthy diet

Answer:

A. Measure and record intake and output.
UAP responsibilities include performing basic nursing tasks, such as measuring I&O, vital signs, and weight. The registered nurse is responsible for assessment, education, and interventions that require specialized nursing knowledge, skill, or judgment.

Related resource: 10 Common Types of NCLEX Questions

2. Establishing Priorities (Safe and Effective Care Environment)

According to the NCSBN, “The nurse promotes achievement of client outcomes by providing and directing nursing care that enhances the care delivery setting in order to protect clients and health care personnel.” The Safe and Effective Care Environment questions evaluate how well prepared you are for assuming these responsibilities.

Question:

A train derails near your hospital. Over 25 people are injured and being transported to the emergency department. Which patient should be assessed first?

A. A 36-year old with a sucking chest wound
B. A 10-year old with a severe leg laceration
C. A 78-year old who has a compound fracture of the left arm
D. A 23-year old who is unresponsive and has a high spinal cord injury

Answer:

A. 36-year old with a sucking chest wound.
Nurses must make difficult decisions about establishing priorities during an emergency. If given immediate attention, the patient with the sucking chest wound can recover. The patient with the severe leg laceration and the patient with the compound fracture can be given temporary care, then fully treated later. The patient with the spinal cord injury will not likely survive and should not be given first priority.

Related resource: Passing the Licensure Exam: An NCLEX Study Plan

3. Antenatal (Health Promotion and Maintenance)

51cg 6-12% of the NCLEX-RN exam will include questions from Health Promotion and Maintenance. This category includes questions on high risk behaviors, aging process, and lifestyle choices, as well as a significant subcategory on pregnancy, birth, postpartum, and newborn care.

Question:

A 32-year old client refuses to have any analgesia or anesthesia during her birth experience. As the nurse assists her during the second stage of her labor, which position should she use to begin pushing?

A. Lying on her left side in the Sims’ position
B. Knee-chest position with head elevated
C. Squatting with her body curved into a “C” position
D. Lithotomy position with high stirrups

Answer:

C. Squatting with her body curved into a “C” position.
Squatting can help assist with the birthing process by enlarging the pelvis and allowing gravity to assist. The “C” position, in which the woman’s body is curved over her knees, is the best position.

Related resource: 5 NCLEX Test Taking Strategies

4. Cultural Awareness (Psychosocial Integrity)

51cg 6-12% of the NCLEX-RN questions relate to Psychosocial Integrity. This category includes questions on chemical and substance dependencies and disorders, mental health, family dynamics, and stress management.

The concept of Culture and Spirituality is utilized throughout the four major categories of the NCLEX-RN exam. According to the NCSBN, Culture and Spirituality refers to the “interaction of the nurse and the client (individual, family or group, including significant others and population) which recognizes and considers the client-reported, self-identified, unique and individual preferences to client care, the applicable standard of care and legal instructions.”

Question:

A nurse is caring for an elderly Vietnamese patient in the terminal stages of lung cancer. Many family members are in the room around the clock performing unusual rituals and bringing ethnic foods. Which of the following actions should the nurse take?

A. Notify visitors with a sign on the door that the patient is limited to clear fluids only with no solid food allowed
B. If possible, keep the other bed in the room unassigned to provide privacy and comfort to the family
C. Contact the physician to report the unusual rituals and activities
D. Restrict visiting hours and ask the family to limit visitors to two at a time

Answer:

B. If possible, keep the other bed in the room unassigned to provide privacy and comfort to the family.
At end of life, spirituality and culture can have increased significance for the patient and their family. It is important for the nurse to provide a culturally sensitive environment and privacy for the family when possible within the hospital routine. Answers A, C, and D would create unnecessary conflict with the patient and their family.

Related resource: Ask an Expert: Guide to the NCLEX

5. Arterial Blood Gases (Physiological Integrity)

The Physiological Integrity category is the largest on the NCLEX-RN exam. Questions from this category can make up 38-62% of the total exam. This category includes questions about basic care and comfort, pharmacological and parenteral therapies, reduction of risk potential, and physiological adaptation.

Question:

The healthcare provider is reviewing the arterial blood gas report for a child with severe, persistent asthma. The blood gas is: pH = 7.28, PaCO2 = 50 mmHg, HCO3 = 25. Which of these assessments are consistent with this child’s arterial blood gas?

A. Kussmaul respirations and muscle twitching
B. Disorientation, headache, and flushed face
C. Rapid, deep respirations and paresthesia
D. Slow respirations, nausea, and vomiting

Answer:

B. Disorientation, headache, and flushed face.
The normal ranges for ABGs are: pH is 7.35-7.45; PaCO2 is 35-45 mm Hg; HCO3 is 20-24eEq/L. This patient has respiratory acidosis. The excess CO2 leads to headache and facial flushing, and the increased acid causes disorientation. Other symptoms of respiratory acidosis include fatigue, shortness of breath, and sleep disturbance.

Related resource: Nursing Lab Values to Know

6. Medication Administration (Physiological Integrity)

The questions on the NCLEX-RN exam can be very specific, and will likely require you to think critically. Read each question carefully, and read all the answers thoroughly before you make your choice. Once you’ve answered the question, try not to second-guess yourself—your first answer is usually the right answer.

Question:

The healthcare provider prepares to administer a corticosteroid to a patient with a diagnosis of asthma. What is the rationale for administering this drug to this patient?

A. Promote bronchodilation
B. Decrease airway swelling
C. Promote expectoration of mucus
D. Prevent respiratory infections

Answer:

B. Decrease airway swelling.
Corticosteroids work by inhibiting the inflammatory response and reducing the mucus secretion of a person with asthma. As a result, the airways are less swollen and less likely to react to asthma triggers.

Related resource: 7 Essential NCLEX Study Tips

7. Total Parenteral Nutrition (Physiological Integrity)

The NCLEX-RN exam is based on knowledge and how you apply that knowledge, and less about specific facts you will need to recall. Study with the goal of learning and understanding the questions and their answers, not merely to memorize.

Question:

During an acute exacerbation of inflammatory bowel disease, a patient is to receive total parenteral nutrition (TPN) and lipids. Which of these interventions is the priority when caring for this patient?

A. Monitor the patient’s blood glucose per protocol
B. Change the administration set every 72 hours
C. Infuse the solution in a large peripheral vein
D. Monitor urine specific gravity every shift

Answer:

A. Monitor the patient’s blood glucose per protocol.
Since total parenteral nutrition can cause hyperglycemia, blood glucose levels must be closely monitored. The TPN solution must be administered via a central venous catheter, not a large peripheral vein. Administration sets should be changed every 24 hours because the high glucose and lipids make the TPN an excellent medium for bacterial growth if the TPN contains lipids.

Related resource: How the NCLEX Works

8. Blood and Blood Products (Physiological Integrity)

Unlike our practice questions, the questions on the NCLEX-RN exam are not organized by subject content—all of the content is integrated. The more practice tests you take, the more adept you will become at understanding how the questions are structured and developing strategies for selecting the right answer.

Question:

Before receiving a transfusion of whole blood, the laboratory and blood bank require a sample of the patient’s blood. Which test will be run?

A. Complete blood count (CBC) and differential
B. Blood culture and sensitivity analysis
C. Blood type and crossmatch
D. Blood type and antibody screen

Answer:

C. Blood type and crossmatch.
A blood type and crossmatch is necessary to ensure a match between the blood donor and the patient receiving the transfusion. An incompatible match could lead to severe adverse events, including death. CBC, differential, and culture and sensitivity test are unnecessary, and an antibody screen is not necessary for a crossmatch.

Conclusion

After you pass the NCLEX-RN exam, you may want to consider advancing your education through our RN to BSN program, or even pursuing an MSN program down the road. That’s because a BSN degree will allow you to become eligible for leadership positions and higher earning potential as a nurse. It’s also essential if you want to pursue more advanced degrees, like Nurse Practitioner. Joyce’s RN to BSN program has an “all-in” tuition model, which means you can finish your degree online in less than 12 months, and the tuition cost is fixed.

In the meantime, we’ve developed time-tested and effective tools to help you pass the NCLEX-RN exam on the first try. Our free eBook, 49 Proven NCLEX Strategies, includes tips for calculating measurements, the best techniques for answering true-or-false questions, and more details about the types of questions that will be asked on the NCLEX-RN exam—in addition to basics like how long the test will take and how much time to spend on each question.

Looking for more NCLEX-RN exam tips and strategies? Download our free e-book now.

We talked to Stephanie Greenwood, Joyce’s NCLEX instructor and assistant director of didactics in the ADN program, to get the inside scoop on the test that every nurse has to pass.

What is the NCLEX?

It’s a national test that’s administered to any candidate who wants to become an LPN or RN. A lot of people know what law boards are. It’s very similar to that, and it’s one of the hardest boards you can take.

We qualify all of our students to become an RN. We prepare our students so they have all the competencies, and can pass on the first try. Last year we were at 88.5 percent passing, which is high—and when you talk about pass rates you talk about first-time pass rates.

Related Resource: 10 Common Types of NCLEX Questions

What is on the NCLEX?

There’s an NCLEX testing plan that breaks it up by subject matter, but it’s really more based on types of subject matter. For example, one of the areas is basic care and comfort. Another area might be pharmacology. Another might be safety and infection control.

Each area is weighted by how many questions are based on that area. They weight things based on where they feel an entry-level nurse will be starting. Right now, that means a lot of med-surg. Medical-surgical floors are where most of our new grads are starting, so there’s going to be a lot of med-surg on the test.

Related Resource: 7 Essential NCLEX Study Tips

How long is the NCLEX?

It really depends on the student. The computer is really smart and it goes by the percentages we were just talking about. It makes sure that every test meets a certain criteria, and it also makes sure your test is not too hard or too easy.

On the RN test you can get anywhere from 75 questions to 265 questions. If the student gets the former, the computer has determined in 75 questions one of two things: Either they really know their stuff and they’ve shown that they’re above the minimum competency, or they really don’t know their stuff and they need to study quite a bit more.

If a student got all 265 questions, that would mean they are really straddling the competency line. The is complicated, but it’s a very smart, adaptive test. After you get past 75 questions, once it determines whether you’re above passing or below passing, it will shut off.

We have quite a few students who pass with 75 questions, and some go through all 265. I would say maybe around 125 is the average number of questions our students see, but I’m guessing on that.

Related Resource: Nursing Lab Values to Know

How is the test formatted?

There are quite a few types of questions. Multiple choice is the most common one. It can also have “select all that apply.” Those usually have five options, and you could have to select just one or all five. They also do things called hot spots. That’s where you’re given a diagram of the human body, for instance, and you’re asked where you’d put your stethoscope.

They also have dosage calculations which are usually fill in the blank, so you have to calculate the dosage amount and you have to fill in your answer. There are also questions where they give you a chart and you have to answer a question based on that. And they do drag-and-drop questions where you have to put things in order. Multiple choice, though, is still the most common question.

How often is the NCLEX rewritten?

We have a major test change every three years. While they’re always updating content and making sure best practices are up to date, they only change the test blueprint every three years. It takes quite a bit of time for a question to become an official NCLEX question.

If you don’t pass, you can take it again, but there is a 45-day waiting period between each attempt.

If you do pass, you won’t find out immediately. It can take up to 10 days but most of my students know in a day or two.

Related Resource: 6 Common NCLEX Mistakes to Avoid

What happens if I don’t pass? What happens if I do?

If you don’t pass, you can take it again, but there is a 45-day waiting period between each attempt.

If you do pass, you won’t find out immediately. It can take up to 10 days, but most of my students know in a day or two.

What types of questions do students have the most trouble with?

It is a learned question style. Instead of asking “What color is the sky today?”, it would say something like “Sally is outside playing in the park, and it’s May with some scattered clouds, and there’s no rain in the forecast. What color is the sky?” It’s going to give you a lot of extra information that we call distractors, and the student needs to learn how to go through those distractors and figure out what’s going on and what the question is actually asking.

We start students out on day one with those types of questions and teach them how to dissect them. As long as they know the context, they should be able to answer the question.

Do you have a favorite type of NCLEX question?

They call them negative questions. It’s asking the student to find the information that’s incorrect. The reason why I like them is that there’s only one correct answer, but it’s actually the wrong answer. The majority of NCLEX questions are actually designed so a student can get it down to a 50/50 choice and then make an educated guess.

The nice thing about a negative question is that there shouldn’t be a 50/50. They should just be able to find the answer, and they are a little bit harder because our brains don’t work that way. We want to find the correct answer, not the negative answer.

Do you have a least favorite type of question?

Yes, and it’s the same one that all of our students dislike, and that’s the “select all that apply” questions. You don’t know how many answers are correct. Two may be correct, or four, or five. You don’t know, and you can’t use the process of elimination. It’s like a 5-part question, and you only get credit for one question even though there are five parts to it.

What advice do you give as an instructor?

One of my biggest pieces of advice is for them to learn to trust themselves. Our students have a really tough time with that. They want to second-guess themselves or say “Well, I’m really not sure if that’s right.” What I always tell my students is if you’ve studied it, you know it. One of the biggest things I see with students is that they’ll convince themselves they need to change their answer. And the majority of the time when they change their answer, they’re changing it from a correct one to a wrong one. You need to trust your gut.

Passing the NCLEX takes time, teamwork, and dedication. Stay in touch with the Joyce community by following us on , and be sure to download our free ebook 49 Proven NCLEX Strategies. Happy studying!

It’s for good reason that the NCLEX might be the hardest test you’ll ever take. Nurses save the lives of patients every day. They’re so good at saving lives that nursing has been considered the most trusted profession in the United States for decades. You didn’t spend years of your life studying for a cake walk, so get ready.

The good news is that 1.3 million people have taken the NCLEX and become nurses, and so can you. Study hard, avoid these six common mistakes, and follow our helpful tips and resources to ensure that you successfully pass the exam. With an NCLEX pass rate consistently higher than the national average, you can count on 51cg to help you put your best foot forward come exam day. Good luck!

Mistake #1: Assuming the NCLEX is like the tests you took in nursing school

Did you perform well on your tests in nursing school? Great! Now get ready for a different measure of success, because the NCLEX truly is a whole different ballgame.

Just because you did well on tests in nursing school doesn’t mean you’ll ace this one. Unlike nursing school exams, which test for knowledge, the NCLEX tests your ability to apply and analyze situations using the nursing knowledge you gained in school. Logic and critical thinking, rather than rote memorization, are emphasized in this test—making it much more difficult and comprehensive.

Tip: Want to get a sense of what taking the exam is like? Check out our list of 8 practice questions to see how NCLEX exam questions differ from your average nursing school test and how you can best prepare.

Mistake #2: Reading quickly like you already know the answer

If you’ve ever been told to “slow down,” you should keep up that mantra when taking the NCLEX. Some of us are methodical and cautious; but when it comes to taking the most important test of our lives against the clock, we all have a tendency to fly through the questions that look familiar. For those who instinctively move quickly, the NCLEX is a killer and will challenge you if you move too fast.

That’s because it doesn’t just test for knowledge and competency; , judgement, reasoning, and thoughtful reflection. There are no shortcuts for these skills.

Read through the questions twice. Assume you do not know the answer.

Tip: Want more strategies for success? Try our free e-book, “49 Proven NCLEX Strategies” to see our top tips for ensuring you pass the exam with flying colors.

Mistake #3: Cramming right before the test

The NCLEX is hard. You might have gotten through nursing school with marathon all-nighters, but last-minute cramming is not going to be enough to pass the NCLEX.

In fact, often has the opposite effect, leading to:

• Mixing up the facts you’ve already learned
• Preventing the connection of old and new information, which is necessary to input ideas into memory
• Reading fatigue during study time, causing low energy during testing
• Anxiety and frustration

Set aside at least a month, and for that month. No cramming needed!

Tip: Instead of cramming for the exam, how about planning for it? Learn how best to structure your NCLEX exam prep with our helpful suggestions: Passing the Licensure Exam: An NCLEX Study Plan.

Mistake #4: Avoiding thoughts about test day

Go ahead, think about it.

Sometimes we avoid thoughts about things that worry us in order to put it off or escape anxiety. But big events like taking the NCLEX require some consideration, and you’ll probably feel more prepared if you think about it more. So go ahead, think about things like:

• Where will I park?
• Can I bring snacks and a water bottle?
• What will parking be like?
• What time should I set my alarm? (And should I set a back-up alarm?)
• Think about each point that’s on your mind, write it down, and then stop worrying about the things you can plan for now!

Mistake #5: Believing failure means you’ll fail again

Many great nurses take the NCLEX more than once. If you’ve failed before, you know what to expect. You know what to focus on, how much time you’ll need, and what areas are particularly hard for you.

The Many test-takers did not pass on the first try. Those now-nurses might have been having a bad day. They might have gotten nervous and flubbed answers, or they might not have studied enough. None of these reasons prevents 14.6 percent of nurses from

It’s okay to be scared of failing. Take a deep breath, study hard, and try again.

Tip: To improve your chances on your first, second, or even third try, read through our favorite NCLEX resources: 60 Best Resources for NCLEX Questions, Prep, and Review Practice. You’ll find great tips for studying and preparing to ensuring that you successfully pass.

Mistake #6: Thinking your notes are good enough

Your notes are not good enough. A study app is not good enough. Even your notes plus a study app are probably not good enough.

Pass the NCLEX with notes. That’s because the NCLEX doesn’t test you on the same questions that you saw in nursing school. Instead, you’ll be tested on your critical thinking skills, so look for new material that will help you conquer the NCLEX’s many challenges.

To pass the NCLEX, you’ll need quality study materials to get through the mother of all tests! Even if you have a study guide you already love, it can be helpful to study more than one source.

Here are a few of our favorites:

1. : Kaplan materials are generally very helpful. This edition includes two practice tests, plus online, book, and video tutorials. It focuses on expert critical thinking strategies and targeted practice.
2. NCLEX RN Mastery app: It’s the 21st century, so of course you need a study app. This free companion includes 1,800 practice questions, quizzes, mnemonics, and strategies.
3. by Bartz, Kumagai, and LaCharity: This popular book focuses on foundational knowledge in care management skills, similar to the NCLEX.

Tip: Looking for even more NCLEX prep resources to ensure you’ll pass the exam? Check out our helpful recommendations here: The Best Books for Passing the NCLEX.

While we can’t tell you what specific questions you’ll see on your NCLEX exam, we can tell you this: Always choose the answer that keeps the patient safe and alive.

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1. Give yourself enough time to study

There isn’t a one-size-fits-all best time to take the NCLEX. Every nurse will have a different NCLEX success story. It’s a matter of finding the time that’s best for you. If your nursing program included a strong NCLEX review course, you might schedule your test just as you graduate. If yours didn’t, you might choose to take some extra weeks or months to study and review. Test registration is typically available starting six weeks before your program ends. Once you decide you’re ready to test, sign up and pay your exam and licensure fees — typically around $300.

Considering those costs, you should give yourself plenty of time to study to ensure you’re ready to pass the first time you take it. Rather than cramming all of your studying into an impossible timeframe, take care of your mind and body as you’re preparing. Find a comfortable study space where you actually enjoy learning and take frequent short and long breaks to keep your brain limber and to allow the information to soak in.

Of course, you still have to think like a nurse. You’ll still need to push yourself and tend to all the other spinning plates in your day-to-day life. Your NCLEX study plan shouldn’t be unpleasant or rushed, but everything about it should be challenging, including the timeline. Give yourself the study hours you need, but schedule the exam as soon as possible so you can pass and get to work as a nurse right away.

We highly recommend allocating a specific amount of time each day and itemize the topics you need to cover during each session. Every student studies differently, but many nursing forums contain by past exam-takers with schedules that worked for them.

Related Resource: 10 Tips for Creating Your Ideal Study Space

2. Know how the test is structured

If your program prepared you well for the NCLEX, skip over this part. If not, and the whole process seems rather murky, it’s important you know how the test is structured.

This outline from the contains percentage ranges for each category on which you’ll be tested. As you read through the categories, it’s a good idea to determine which areas you believe to be your strengths, as well as the areas you’ll need to study especially thoroughly in preparation for the exam.

It’s also useful to know that the NCLEX is administered with computerized adaptive testing, or CAT. That means that you won’t be needing to sharpen any number-two pencils and should expect to take the test in front of a screen. Questions will be of four major types: drag-and-drop, multiple choice, hot spots, and chart/exhibit.

Another unique factor in the NCLEX is that the length of it depends on the test taker. Registered nurse candidates must answer at least 75 questions correctly, which is the shortest possible test length. However, incorrect answers lead to a longer test, with 265 being the highest possible number of questions contained within the exam. The NCLEX can take up to six hours, but the majority of test takers require less than the maximum time allocation.

If your test ends up being over 75 questions, remember to stay positive. A longer test doesn’t mean you failed, and anyway, it’s rare for anyone to reach that maximum number of questions. As long as you’re still in the running for a passing score, the computer will continue administering new questions until enough information is gathered to settle on a pass or fail. This system is helpful in that it helps test-takers focus on the questions in front of them one at a time — if the test is still going, it’s still possible to pass!

Related Resource: 8 Tips for Passing the NCLEX-RN Exam

3. Implement your NCLEX study plan

One of the best ways to ensure that you ace the NCLEX is to take a few practice tests in preparation. The Internet has plenty of reputable resources when it comes to study guides and example NCLEX test questions. Once you have a nice collection of resources both online and in print, consider crafting a routine for your study days with a good balance of practice tests, reading materials, and enough downtime between to give you the brainpower you need to absorb the most possible information. Some test candidates like to study in intense, short bursts while others prefer to make studying an interwoven part of their everyday routines.

Studying for the NCLEX with a group of friends can help ensure your exam successWhatever your NCLEX study plan may be, it can be wise to buddy up with a friend from your cohort who’s also preparing to take the exam. Although preparation is hard work, it can be rewarding — and even fun — to study with someone else. Even though you can’t take the test together, you’ll memorize more with two heads instead of one, and your individual strengths can help each other’s weaknesses.

Think of fun ways to study with a friend or group, like taking breaks to grab ice cream or planning to watch a favorite movie together after your study session. Building these sorts of rewards into your exam planning reinforces positive associations with the test material and keeps stress levels lower — which in turn means that information retention will go up.

Related Resource: Best Guides for Passing the NCLEX-RN

4. Consider an NCLEX prep course

Some graduates might need a little extra oomph when they begin studying apart from their nursing instructors. The structured delivery of an NCLEX prep course can be helpful to those who struggle setting aside time to study between other activities. If you’re someone who learns better in a structured environment, there are and in classrooms. NCLEX prep courses do cost a significant amount of money, yet for many students, the price is worth it for the assurance that a structured learning environment can bring.

Prep courses also serve as a fantastic option for the students who didn’t take or schedule the test immediately after graduation. If you are newly graduated from your nursing program, much of the material covered in the NCLEX may still be fresh in your brain. However, a prep course will help you bring the knowledge to the forefront of your mind if it’s been awhile since graduation. With a structured prep course, you can save yourself the time you would have spent sorting out study materials and old notes. Prep courses aren’t for everyone, but they can benefit a lot of nursing students.

Related Resource: Normal Lab Values in Nursing

5. Give yourself a break the day before the test

As the big day approaches, give yourself a day away from NCLEX materials. At this point, you’ve put in the hard work and dedication needed to prepare yourself for this pivotal moment in your nursing career — so enjoy a relaxing break before you put your knowledge to the test.

A day of rest can relax you, preparing you to take the test calmly and thoughtfully, employing the knowledge you’ve already gained and recently reviewed. Cramming the night before will more likely result in a frantic and muddled mind. The material is in there, so a break is well deserved. Make sure to get plenty of sleep and eat a healthy, well-balanced diet leading up to the test time.

6. Only bring essentials with you to the test

On the day of the exam, you’ll only need to be confident and do your best. Your goal should be to minimize distractions of any sort so you can focus on the exam itself. Plan to show up to the testing site in loose, comfortable layers, so you aren’t distracted by too-tight sleeves or itchy fabrics. Layering also means you won’t be bothered by fluctuations in temperature — you can simply make adjustments mid-test.

To help stay calm and relaxed in the moments leading up to the test, try to arrive about a half-hour early to the testing location. Don’t arrive too hungry or too full, and make sure to stay well-hydrated so your brain can perform at its peak. Last but not least: Remember to breathe and feel proud of all of your accomplishments thus far. You’ve worked hard to be here, and taking the NCLEX is your time to shine and show how much you know!

Related Resource: 5 NCLEX Test Taking Strategies

7. Know where to get the results.

Once you’ve taken your exam, any amount of time to find out the results can feel like a long time. Luckily there is more than one option for receiving your NCLEX results.

Normally, results are mailed to you approximately six weeks after the exam day. If that seems like too long to wait, some approved services are available for a fee that will reveal your results to you within 48 hours. If for any reason the exam is unsuccessful, you can take it again in 45 days. But if you’ve prepared well and followed through with a concerted study regimen, chances are you did better than you imagine. When you get your results, whatever they may be, make sure to congratulate yourself on the effort and commitment you made to arrive at such a major milestone.

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