NCLEX-RN Study Guide and Practice Test

What is the NCLEX-RN Exam?

The NCLEX-RN exam is for aspiring nurses who have completed their educational requirements and are ready to apply for state licensure as registered nurses. The exam was developed by the National Council of State Boards of Nursing (NCSBN) and its content is universal, which means it does not vary by state. It measures the competencies an entry-level nurse needs to perform their role in a safe and effective manner. There are good options available for NCLEX-RN prep to help aspiring test-takers ready themselves for the exam.

How Many Questions Are on the NCLEX-RN Exam?

Since the NCLEX-RN exam uses computer adaptive testing (CAT), the number of questions varies. However, as of October 1, 2020, there are between 75 and 145 potential questions on the exam. Test-takers have a maximum of five hours to complete the exam. There are several question types, including multiple-choice or response, fill-in-the-blank, exhibit item, ordered response, or graphic item.

The test is passed only when the computer assesses that the candidate has reached the passing standard with a 95% confidence interval.

What Content Does the NCLEX-RN Exam Cover?

The NCLEX-RN examination is divided into four client need categories describing aspects of care. Two of these have subcategories, making a total of eight content area categories. Each of these content areas is composed of differing percentages for the final exam, with some variation based on candidate ability. They assess a candidate's understanding of critical thinking and clinical decision-making skills, which are essential to the practice of nursing. Each content area has a main area and a wide range of other related content that can be explored in an NCLEX-RN review during study preparation. Here are the relative percentages of the categories and subcategories within the NCLEX-RN exam, as well as a guide to the competencies within each subcategory.

• Safety and Effective Care Environment
  • Management of Care
  • Safety and Infection Control
• Health Promotion and Maintenance
• Psychosocial Integrity
• Physiological integrity
  • Pharmacological and Parenteral Therapies
  • Physiological Adaptation
  • Reduction of Risk Potential
  • Basic Care and Comfort

Management of Care- 20%

This content area focuses on the management of care for protecting fellow personnel and nursing clients. Among other skills, this area of the NCLEX-RN exam includes plans of care, management of workloads, transcribing care provider orders, and utilizing available resources. This NCELX-RN examination content area also includes many related sections such as advance directives, advocacy, case management, and the rights of clients. It also involves management concepts, interdisciplinary collaboration, informed consent, and ethical practice.

Safety and Infection Control- 12%

NCLEX-RN exam candidates will be assessed on how to protect personnel and clients from environmental and health hazards, such as injuries, allergies, and emergency response plans. This content area includes hazardous material handling, error documentation, infection control, equipment use, and proper identification. Other related content may include transmission and surgical precautions or restraints, as well as room assignments, proper identification, and ergonomic principles used in assessing clients for assistive devices.

Health Promotion and Maintenance- 9%

The competencies within this content area assess a candidate's knowledge of problem prevention, as well as growth, development, and optimal health strategies. This includes how to supply care and education for a range of clients, including prenatal and newborns, as well as adults. This content area of the NCLEX-RN exam covers health risk education for clients and community-wide health education and promotion. This area also has information on how to perform health screenings, as well as high-risk health behavior education. In addition, the test-taker will need to learn about home care and comprehensive health assessments.

Psychosocial Integrity- 9%

This content area focuses on the emotional, mental, and social health of clients during a trying time, including severe and chronic mental illness. Competencies include a candidate's ability to assess a client for abuse, potential violence, and/or their ability to cope with stress. This involves incorporating cultural practices and beliefs in care planning, as well as providing end-of-life care while involving the client's family. Other competencies include how to provide care for disabled clients, how to recognize stress in a client, and how to assess a client for substance abuse. Therapeutic techniques and environments are also part of this NCLEX-RN exam area.

Pharmacological and Parenteral Therapies- 15%

Nurses administer medication and parenteral therapies, and this content area assesses their ability to provide that care. This includes how to administer blood products or medications for pain management. Candidates need to know how to evaluate a client's medication response and titrate medication dosage, as well as how to take part in medication reconciliation. Competencies contain safely handling and maintaining medication, including the handling of high-risk substances, as well as monitoring intravenous sites. This also includes the administration of parenteral nutrition.

Physiological Adaptation- 14%

All successful NCLEX-RN exam candidates will have to know how to care for clients with acute, chronic, or life-threatening conditions. This content area includes multiple competencies within its field of care. This involves providing suctioning, wound care, ostomy care, pulmonary hygiene, and postoperative care. Candidates will need to know how to monitor arterial lines, pacing devices, telemetry, hemodialysis, and continuous renal therapy, as well as tissue perfusion, hemostasis, and hemodynamics. Other competencies include monitoring devices for draining and caring for clients on ventilators.

Reduction of Risk Potential- 12%

Competencies in this content area of the NCLEX-RN exam address how a nurse can reduce health complications. This entails how to perform diagnostic testing, how to respond to vital sign changes in a client, and monitoring results as needed. Candidates need to know how to insert, maintain, or remove catheters, IV lines, and nasal/oral GI tubes. Further competencies include injury prevention, maintaining venous return devices, and evaluating responses to any procedures. Test-takers will also have to educate clients about treatments, including postoperative education, and manage clients during and following moderate sedation.

Basic Care and Comfort- 9%

This content area of the NCLEX-RN exam covers how to support a client in their daily lives, providing comfort and helping them compensate for any impairments. This includes any elimination or irrigation management, as well as assessments of skin health and the need for pain interventions. These competencies include the ability to recognize complementary therapies and potential contraindications, as well as how to monitor client nutrition or provide tube feedings. Candidates will need to know how to evaluate client intake and output, as well as how to assess client sleep/rest and to perform post-mortem care if needed.

NCLEX-RN Exam Prep

The best way to approach an exam of this size is with a thorough study plan that includes a comprehensive NCLEX-RN review. A good place to begin is a sound understanding of the question types. Most of the questions are in a text-based, multiple-choice format with one correct answer and three other plausible, yet incorrect, answers. Other NCLEX-RN exam questions include multiple responses, where candidates are asked to select all correct answer choices. Test-takers may also be asked to re-order answers using the drag/drop method or to fill in the blank of a question with a missing element. Lastly, there may be an image or graphic from which candidates will have to choose the correct area by clicking the mouse.

The sheer volume of material to review suggests a significant amount of study time to prepare for the NCLEX-RN exam- up to three months depending on a candidate's available time. There are test plans available from the official NCLEX website. These plans offer a detailed breakdown of test content and allow a test-taker to map their college coursework to test questions and check that they have covered all the material. Candidates should seek out a quality NCLEX-RN study guide to structure their review, as well as to take the bare minimum of one practice test. There is also an exam tutorial on the NCLEX website to familiarize test-takers with the experience of taking a computer-adaptive test using their specific software.

NCLEX-RN Exam Study Guide

A good NCLEX-RN exam study guide and practice test can help structure a candidate's study time. A practice test will help by mapping scores to content areas and identifying a candidate's biggest challenges. Test-takers can then restructure their review and focus on their most challenging content areas. There are several formats available depending on a test-taker's preference. Physical NCLEX-RN textbooks may be found in libraries and bookstores, and digital ones can be found on the NCLEX website or other online sources. Text-based practice tests require manual grading, while online practice tests typically grade automatically and break down results into content areas.

NCLEX-RN Logistics and Registration

Before any candidate can register for the NCLEX-RN exam, they must first apply for licensure with their state's Nursing Regulatory Body (NRB). Once this is complete, a candidate is eligible to register for the NCLEX-RN exam through Pearson VUE. Candidates will not receive an NCLEX authorization to test email until the NRB has approved this application. Once approved, registration can be done by phone or online. Candidates can call the Pearson VUE NCLEX Candidate Service and pay the $200 fee with a valid credit or debit card. They can alternately go to the Pearson VUE website and pay by either a valid credit or debit card or from a third-party organization, such as a nursing school. Candidates will then have 365 days to take the exam, choosing a date and location at the time of registration. There are multiple available testing locations across the country.

Part of thorough NCLEX-RN test prep is becoming familiar with testing site policies. Candidates must review all test-day restrictions before arriving at the official test site. Test-takers must bring an official ID, arrive 30 minutes early, and be prepared to provide biometric information to confirm their identity. The test site will provide a calculator and erasable note board. Nothing else will be allowed into the testing room. Candidates can download the latest NCLEX Candidate Bulletin, which includes all administrative information needed for the test, as well as results and scoring information.

The NCLEX-RN exam involves significant preparation due to its numerous competencies within its content area. However, thorough test preparation, including the use of quality a study guide and practice test, can help candidates approach this final hurdle toward nursing licensure in a structured and productive manner.

Expert Contributor

Stephen Thorne

Stephen received his BSN from Virginia Commonwealth University in 2012. He has completed 12 additional graduate courses toward ongoing pursuit of an MSN in Acute Care. His nursing experience includes 5 years of high acuity nursing in Emergency departments, 4 years in behavioral health nursing in support of individuals suffering from substance use disorder, and 2 years as a nurse manager. Stephen has experience with both HESI and NCLEX preparation courses, as well as GRE preparation for nursing and non-healthcare graduate programs, and the Praxis from the education arena.