HealthApril 16, 2018

Understanding the NCLEX-RN exam: A nursing student's perspective

The NCLEX-RN exam is like no other! This exam will hunt down your every weakness and challenge you on it! OK, maybe it is not that bad-but you definitely will need to be knowledgeable in many areas to succeed on the NCLEX! Even the things you may have forgotten from the beginning of your nursing program you will need to remember. Let's sort through some facts and misunderstandings about this exam!

The NCLEX is based on an analysis of new graduates. What this means is that test administrators looked at graduates across North America to see what knowledge and skills they possess. The analysis looked at acute care settings, as that is where most new graduates start their nursing career.

It is important to acknowledge that nursing specialties are not tested on the NCLEX-RN exam. The NCLEX exam is testing you on what you should know as a newly practicing nurse in an acute setting-but remember that could be a rural or urban setting. If you are a new nurse working in a rural area and a laboring mom walks into your ER, you should know how to safely care for her. This does not mean you have the expertise to work in the obstetrical unit; rather, you need the knowledge and ability to care for this mom safely.

What does CAT mean? You will hear it referred to as a CAT adaptive exam. CAT refers to Computer Adaptive Testing. This means that the exam is being created as you take it! The computer uses an algorithm to decide what question it will ask you next. It is determining your ability compared to the passing standard. Think of the passing standard as a set level that is used to determine if you are above it or below it.

Every time you answer a question it determines what it will ask you next. As the exam continues the computer's ability will become more and more accurate in asking you a question. It determines the question it will ask you based on the following criteria:

  1. You will have enough questions from each content area to match the test plan percentages. The test plan outlines the percentages of each area the exam can include. It has a minimum and maximum percentage of questions in each area that it can contain.
  2. The question will be a question that you have a 50% chance of getting correct. The computer does this so that the question is fair and isn"t too difficult or too easy.
  3. You will not receive a question that you have within a year. That means that if you are a repeat writer you will not have the same question within that year.

One misunderstanding that I often hear students express is,"my exam was ALL insert client need area!”

Many students feel that their exam included many questions from one particular area or client needs section. For example, I recently worked with a student who stated: “My exam was 75% pharmacology! It was so unfair!” This is a misconception that some students may have.

The NCLEX-RN exam is based on the client needs areas. These areas are as follows:

  1. Safe and Effective Care Environment 
    1. Management of care
    2. Safety and infection control
  2. Health Promotion and Maintenance
  3. Psychosocial Integrity
  4. Physiological Integrity
    1. Basic care and comfort
    2. Pharmacological and parenteral therapies
    3. Reduction of risk potential
    4. Physiological adaptation

The test plan outlines how much of the exam is needed in each category and subcategory. For example, the example that I just referred in which the student had stated that the exam felt like 75% of her exam was pharmacology - in fact could not be more than 18% of the entire exam.

The good news is that your exam will not be comprised of just one of these client needs areas! It will however, include ALL of these client needs areas. The NCLEX-RN exam requires you to be above the passing standard in all of these areas. That means you could ROCK all of the above areas, except the Pharmacological and Parental Therapies section, and still fail this exam.

The first step to passing the NCLEX-RN exam is knowing and understanding the exam itself. This understanding can assist you in your preparation and help you choose the resources you will need to be successful!

Questions about the NCLEX? Click here to get more info from the NCSBN.

Written by Shelly Luhning RN BScN MN ENC(C)
NCLEX Education Canada
Undergraduate Adjunct Professor University of Regina Saskatchewan Collaborative Bachelor of Science in Nursing School of Nursing Saskatchewan Polytechnic Saskatoon Campus

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