Prepare for NCLEX: How to Secure a Nursing License at Once

By Sarah Collins

02/23/2022

  • The NCLEX RN exam is a nurse licensure exam administered in the United States, Canada, and Australia.
  • The NCLEX RN exam covers medical, pediatric, psychiatric, obstetric, and surgical subjects.
  • There are many ways to prepare for the NCLEX exam, including study guides or enrolling in an in-person/online course.

Are you itchy to become a practicing nurse? Then sitting for the NCLEX has to be a priority. After all, it’s a necessary step to securing your license.

Your goal is to ace the exam and go on to gain your license as a registered nurse. But how do you prepare for the NCLEX?

This guide highlights all essentials to know for the exam. Learning about the exam, expected topics, and standard duration will surely assist your preparation. Ready? Here we go!

What Is NCLEX?

NCLEX Two Factors

The National Council Licensure Examination (NCLEX) is a nurse licensure exam conducted to induct students from an accredited nursing program into the profession as entry-level nurses. Administered by the National Council of State Boards of Nursing (NCSBN), NCLEX is available in the United States, Canada, and Australia.

The NCLEX is categorized into NCLEX-PN (for aspiring licensed practical nurses) and NCLEX-RN (for registered nursing applicants). While the former emphasizes care coordination, the other focuses on care management and evaluation of the advanced practice scope of registered nurses.

What Does NCLEX Cover?

NCLEX is quite a comprehensive exam. The test covers all materials learned during nursing school, including medical, pediatric, psychiatric, obstetric, and surgical subjects.

Mostly, it’s a multiple-choice exam, with some fill-in-the-blank, drag-and-drop, and charting questions mixed in the format. All multiple-choice questions have four possible answer choices.

The following are eight nursing subfields that NCLEX covers:

Management of Care – 20%

This section covers topics like Advanced Directives, Advocacy, Case Management, Client Rights, Concepts of Management, Confidentiality, Continuity of Care, Quality Improvement, Delegation, Establishing Priorities, Ethical Practice, Informed Consent, Legal Responsibilities, Referrals, and Supervision.

Pharmacological and Parenteral Therapies – 15%

This section tests your knowledge of the following: Adverse Effects, Contraindications, Blood and Blood Products, Central Venous Access Devices, Chemotherapy, Expected Effects, Intravenous Therapy, Medication Administration, Pharmacological Pain Management, Total Parenteral Nutrition, and Dosage Calculations.

Physiological Adaptation – 14%

This section covers concepts like Alterations in the Body Systems, Fluid and Electrolyte Imbalances, Hemodynamics, Medical Emergencies, Pathophysiology, and Unexpected Response to Therapies.

Reduction of Risk Potential – 12%

This section covers Diagnostic Tests, Laboratory Values, Potential for Complications from Surgical Procedures, and Health Alterations and Therapeutic Procedures.

Safety and Infection Control – 12%

This section covers Accident Prevention, Error Prevention, Hazardous Materials, Surgical Asepsis, Standard Precautions, and Use of Restraints.

Health Promotion and Maintenance – 9%

This section covers topics like Aging Process, Ante/Intra/Postpartum and Newborn Care, Developmental Stages and Transitions, Disease Prevention, Health Screening, Lifestyle Choices, Physical Assessment Techniques, Health Promotion Programs, High-Risk Behaviors, and Self-Care.

Psychosocial Integrity – 9%

This section covers concepts like Coping Mechanisms, Grief and Loss, Mental Health Concepts, Spiritual Influence on Health, Sensory/Perceptual Alterations, Stress Management, Support Systems, Therapeutic Communication, Chemical Dependency, Behavioral Interventions, Crisis Intervention, Coping Mechanisms, End of Life Care, and Family Dynamics.

Basic Care and Comfort – 9%

This section covers concepts like Assistive Devices, Elimination, Mobility, Nonpharmacological Comfort Interventions, Nutrition, Oral Hydration, Personal Hygiene, and Rest and Sleep.

How Many Questions Are in NCLEX?

Since the NCLEX exam is an adaptive test, it depends on how often you provide the correct answer. At a minimum, expect to answer 75 questions versus 265 questions at most. Fifteen experimental questions aren’t factored in your overall grade.

Who Is Eligible for NCLEX?

All students who have completed an accredited registered nursing program can take the NCLEX RN exam.

All eligible test takers must register for the NCLEX RN exam through Pearson Vue, the most popular certification exams administrator across different industries and modalities.

Lastly, different states have different requirements for a test taker to become licensed.

These criteria range from a thorough background check and proof of English Language proficiency to letters of recommendation from past leaders and self-report on any concerns that may jeopardize one’s ability to work as a nurse, including gambling and alcohol addictions.

One common denominator with these state requirements is proving you’re of high moral character.

What Is the Difference Between a Temporary and Permanent Nursing License?

Test takers receive a temporary license when they successfully pass NCLEX. Waiting for your permanent permit can take anywhere from a few days to a few weeks. Luckily, you can begin applying for jobs with a temporary license.

Suppose you get a nursing job while awaiting your permanent license. In that case, you may encounter some work restrictions, including the inability to perform specific tasks, until you receive your permanent papers.

Is My Nursing License Valid in a Different State From Where I Obtained It?

It depends on the state. Some states participate in the Nurse Licensure Compact (NLC) program, enabling license validity from participating states. This arrangement is especially advantageous for registered nurses that plan on working as travel nurses.

States not part of the Nurse Licensure Compact program are California, Nevada, Oregon, Washington, Minnesota, Illinois, New York, and Connecticut.

How Much Does NCLEX Cost?

Typically, NCLEX costs depend on the state you reside in, as each state has its unique requirements and licensing fees.

For example, all prospective RNs must pay $200 to Pearson Vue to take the test in Louisiana. This amount goes on top of a $240.75 fee for a temporary license and a $140.75 for a permanent license.

How Has COVID Affected NCLEX?

Due to the COVID-19 pandemic, there have been a few changes to testing procedures. For starters, exam time has been capped at five hours (from six), and the maximum number of questions to 145.

In addition, testing centers have the authority to allow for a maximum number of candidates every day to better practice social distancing guidelines.

Kindly refer to your state’s licensing boards for the up-to-date changes, as they may vary in response to the severity of the pandemic.

How to Study for NCLEX

There are numerous ways to prepare for NCLEX.

One excellent strategy is to optimize the endless array of study guides available, covering all exam items. These study guides also have plenty of quizzes and practice tests to test how often you provide correct answers alongside relevant lectures and passages.

Also, test takers can benefit from accredited NCLEX review courses (in-person or online) from reputable sites, such as registerednursing.org, nursing.com, EZ NCLEX, Hurst, Kaplan, Elsevier, and others. These review courses have strengths and weaknesses regarding cost, format, number of free practice questions, depth of career guides, and ease of use.

All nursing students are also encouraged to create a study plan, which reserves specific study hours every day. Each block should focus on one vital area (e.g., clinical concept or weakness), incorporating passage review and answering test questions.

What Kind of Test Is NCLEX?

NCLEX uses computerized adaptive testing (CAT) to assess performance by adjusting the difficulty level of each question based on the number of correctly or incorrectly answered questions.

Correctly answering more questions results in more complex questions. In contrast, incorrectly answering more questions results in more straightforward questions.

With this algorithm, the exam automatically ends when it’s clear that you have done well or have failed to achieve a passing grade. It establishes a baseline grade (“passing line”) with a 75 question minimum. In short, the higher the frequency of a correct answer, the more likely you are to pass.

The highest number of questions test takers can write is 265 within a maximum of 6 hours. Note that reaching 6 hours is highly unusual, with most test-takers taking between 2 and 3 hours to complete the test.

If test takers run out of time, the grading algorithm will only review the last 60 questions answered. All questions must fall above the passing line to pass the test.

How Is NCLEX Scored?

NCLEX is scored based on two factors — demonstrating competency and answering a minimum of 75 questions to achieve at least a 95% confidence interval.

Competency is assessed up to a maximum of 265 questions or the maximum time allowed of 6 hours. There are no time limits to answer any question, regardless of format (multiple-choice, drag and drop, etc.).

Are There Breaks While Taking NCLEX?

Yes. All test takers have two optional breaks — one after 2 hours of testing and another after 3.5 hours.

Is NCLEX Easy to Pass?

Answering whether or not NCLEX is easy to pass is all relative. One test taker may find it exceptionally easy, and another may find it difficult.

According to 2017 results by the National Council of State Boards of Nursing, the U.S. passing rate was 87%, dropping down to 46% for second attempts. One may surmise that it’s easier for first attempt test takers and much harder for second attempt test takers.

What Happens if I Fail NCLEX?

If a first-time test taker has failed, a complete test will provide a diagnostic profile to help concentrate on weak areas, allowing ample time to prepare for a second test. Luckily, test takers who fail the first time can retake the test 45 days afterward, up to eight times in a single year.

Additionally, you’ll receive a diagnostic profile that identifies all problem areas by showing the number of correct answers by category. This diagnostic profile will allow you to focus on weaknesses before your next test. Be sure to spend extra time on NCLEX practice questions after this.

How Fast Do I Get My Results?

Usually, it takes up to six weeks to get your test results back. However, NCLEX takers can use the quick result service for less than $10 to receive their results in two business days.

Recommendations for Preparing for the Exam

There are many ways to prepare for the NCLEX exam. The method of preparation depends on your preferred learning method. For example, some prospective nurses are highly visual learners, while others prefer heavy repetitive reading.

Here Are Our Favorite Tips.

Use Study Aids. Our preferred study aids include Kaplan NCLEX-RN Test Prep, the UWorld NCLEX-RN Content Review Guide Book, and the HESI Live Review Workbook for NCLEX-RN.

Master the NCLEX Format. Understanding the NCLEX format and its computerized adaptive testing method will allow you to avoid misconceptions about the test (e.g., required minimum number of questions and hours).

Take an NCLEX Prep Course. There are many NCLEX prep courses available to bring up your level of proficiency in no time. Popular NCLEX prep courses include Brilliant Nurse, GraduateX, Kaplan Nursing, Board Vitals, ATI, and D&D Nursing Educators.

Avoid Referring to Real-World Practice. All items in the NCLEX focus on textbook knowledge. Avoid using your experience in a real-world setting, which may not always apply the same concepts to a tee.

Remember Patient Safety First. Many questions on the NCLEX exam have many priority phrases such as “immediate action” and “most important.” When in doubt, pick the option that will result in less harm (or death) caused to the patient.

What Next After Taking NCLEX?

What happens after you take the NCLEX exam depends on whether or not you pass or fail.

If you pass the NCLEX exam, you become an official registered nurse or practical nurse. All scores are published on your state’s Board of Nursing website. Once posted, feel free to apply for all jobs you want, reasonably aligned with your skill level and expectations.

Note many hospitals hire new graduates right out of the gate. However, other hospitals and care institutions may require you to participate in a nurse residency program. These intra-organized nurse residency programs last up to a year, applying both theory and hands-on learning.

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