NCLEX: Licensing Examination

Licensing Examination: Overview

Focus topic: Licensing Examination

The National Council Licensure Examination for Registered Nurses (NCLEX-RNs®) is administered to graduates of nursing schools to test the knowledge, abilities, and skills necessary for entry-level safe and effective nursing practice. The examination is developed by the National Council of State Boards of Nursing, Inc. (NCSBN), an organization with representation from all state boards of nursing.1 The same examination is used in all 50 states, the District of Columbia, and United States possessions. The exam is also administered at international test centers worldwide. Students who have graduated from baccalaureate, diploma, and associate-degree programs in nursing must pass this examination to meet licensing requirements in the United States.

Licensing Examination: The Test Plan

Focus topic: Licensing Examination

The NCSBN prepares the test plan used to develop the licensing examination. The test plan is based on an analysis of current nursing practice and the skills, abilities, and processes nurses use to provide nursing care.

Licensing Examination: Practice Analysis: The Foundation of the Test Plan

Focus topic: Licensing Examination

The NCLEX-RN test plan is based on the results of a practice analysis conducted every 3 years of the entry-level performance of newly licensed registered nurses and on expert judgment provided by members of the National Council’s Examination Committee as well as a Job Analysis Panel of Experts.1, 2, 5 The job analysis asks newly graduated nurses to rank the nursing activities that they perform on a regular basis. The questions used on the test plan, therefore, include those activities that nurses commonly perform. For example, the 2008 RN practice analysis revealed that nursing practice commonly involved activities such as preparing and administering medications, using rights of medication administration; ensuring proper identification of client when providing care; applying principles of infection control (e.g., hand hygiene, room assignment, isolation, aseptic/sterile technique, universal/standard precautions); performing emergency care procedures (e.g., cardiopulmonary resuscitation, abdominal thrust maneuver, respiratory support, automated, external defibrillator); recognizing signs and symptoms of complications and intervening appropriately when providing client care; reviewing pertinent data prior to medication administration (e.g., vital signs, lab results, allergies, potential interactions).

Less commonly performed activities included providing care and/or support for a client with non-substance related dependencies; assisting client and staff to access resources regarding genetic issues; incorporating alternative/complementary therapies into client plan of care (e.g., music therapy, relaxation therapy), and performing post-mortem care.

The National Council of State Boards of Nursing also used the findings from the Practice Analysis activity statements to generate knowledge statements, the knowledge needed by newly licensed nurses to provide safe care.5 The findings of this second report are used to inform item development for the NCLEX-RN examination.

Licensing Examination: Test Item Writers

Focus topic: Licensing Examination

Nurse clinicians and nurse educators nominated by the Council of State Boards of Nursing to serve as item writers write the test questions on the NCLEX-RN exam. Because the item writers come from a variety of geographical areas and practice settings, the test items reflect nursing practice in all parts of the country.

Licensing Examination: Test Plan Details

Focus topic: Licensing Examination

Test plans, or test blueprints, are developed to indicate the components and the relative weights of the components that will be tested on an exam. Because exams test both content (knowledge) and process (critical thinking, synthesis of information, clinical decision-making), test plans usually have two or three dimensions. The test plan for the NCLEX-RN addresses two components of nursing care: (1) client needs categories and (2) integrated processes, such as the nursing process, caring, communication and documentation, and teaching/ learning.Representative items test knowledge of these components as they relate to specific health care situations in all of the four major areas of client needs. The questions developed for the test plan are written to test nursing knowledge and the ability to apply nursing knowledge to client situations.

Licensing Examination: Client Needs

Focus topic: Licensing Examination

The health needs of clients are grouped under four broad categories: (1) safe, effective care environment; (2) health promotion and maintenance; (3) psychosocial integrity; and (4) physiologic integrity. Two of these categories include subcategories of related and specified needs.Understanding the category of client needs is key ( ) to recognizing the types of questions that are found on the licensing exam and the relative emphasis given to the category based on the percentage of questions from that category on the exam.

Licensing Examination: Integrated Processes

Focus topic: Licensing Examination

The NCLEX-RN test plan also is organized according to four integrated processes. These include the nursing process, caring, communication and documentation, and teaching/learning.

Licensing Examination: The Nursing Process

Focus topic: Licensing Examination

The NCLEX-RN test plan includes questions from all steps of the nursing process. The five phases of the nursing process are: (1) assessment, (2) analysis, (3) planning, (4) implementation, and (5) evaluation.

Assessment. Assessment involves establishing a database. The nurse gathers objective and subjective information about the client, and then verifies the data and communicates information gained from the assessment.

Analysis. Analysis involves identifying actual or potential health care needs or problems based on assessment data. The nurse interprets the data, collects additional data as indicated, and identifies and communicates the client’s nursing diagnoses. The nurse also determines the congruency between the client’s needs and the ability of the health care team members to meet those needs.

Planning. Planning involves setting outcomes and goals for meeting the client’s needs and designing strategies to attain them. The nurse determines the goals of care, develops and modifies the plan, collaborates with other health team members for delivery of the client’s care, and formulates expected outcomes of nursing interventions.

Implementation. Implementation involves initiating and completing actions necessary to accomplish the defined goals. The nurse organizes and manages the client’s care; performs or assists the client in performing activities of daily living; counsels and teaches the client, significant others, and health care team members; and provides care to attain the established client goals. The nurse also provides care to optimize the achievement of the client’s health care goals; supervises, coordinates, and evaluates delivery of the client’s care as provided by nursing staff; and records and exchanges information.

Evaluation. Evaluation determines goal achievement. The nurse compares actual with expected outcomes of therapy, evaluates compliance with prescribed or proscribed therapy, and records and describes the client’s response to therapy or care. The nurse also modifies the plan, as indicated, and reorders priorities.

Licensing Examination: Categories and Subcategories of Client Needs

Focus topic: Licensing Examination

A. Safe, Effective Care Environment

1. Management of Care—Providing and directing nursing care that enhances the care delivery setting to protect clients, family/significant others and health care personnel. Related content includes but is not limited to:

Advance Directives
■ Advocacy
■ Case Management
■ Client Rights
■ Collaboration with Multidisciplinary Team
■ Concepts of Management
■ Confi dentiality/Information Security
■ Consultation
■ Continuity of Care
■ Delegation
■ Establishing Priorities
■ Ethical Practice
■ Informed Consent
■ Information Technology
■ Legal Rights and Responsibilities
■ Performance Improvement (Quality Improvement)
■ Referrals
■ Supervision

2. Safety and Infection Control—Protecting clients, family/significant others and health care personnel from health and environmental hazards. Related content includes but is not limited to:

■ Accident/Injury Prevention
■ Emergency Response Plan
■ Ergonomic Principles
■ Error Prevention
■ Handling Hazardous and Infectious Materials
■ Home Safety
■ Reporting of Incident/Event/Irregular Occurrence/Variance
■ Safe Use of Equipment
■ Security Plan
■ Standard Precautions/Transmission-Based Precautions/Surgical Asepsis
■ Use of Restraints/Safety Devices

B. Health Promotion and Maintenance

The nurse provides and directs nursing care of the client and family/significant others that incorporates the knowledge of expected growth and development principles, prevention and/or early detection of health problems, and strategies to achieve optimal health. Related content includes but is not limited to:

■ Aging Process
■ Ante/Intra/Postpartum and Newborn Care
■ Developmental Stages and Transitions
■ Health and Wellness
■ Health Promotion/Disease Prevention
■ Health Screening
■ High Risk Behaviors
■ Lifestyle Choices
■ Principles of Teaching/Learning
■ Self-Care
■ Techniques of Physical Assessment

C. Psychosocial Integrity

The nurse provides and directs nursing care that promotes and supports the emotional, mental, and social well-being of the client and family/significant others experiencing stressful events, as well as clients with acute and chronic mental illness. Related content includes but is not limited to:

■ Abuse/Neglect
■ Behavioral Interventions
■ Chemical and Other Dependencies
■ Coping Mechanisms
■ Crisis Intervention
■ Cultural Diversity
■ End of Life Care
■ Family Dynamics
■ Grief and Loss
■ Mental Health Concepts
■ Religious and Spiritual Influences on Health
■ Sensory/Perceptual Alterations
■ Stress Management
■ Support Systems
■ Therapeutic Communication
■ Therapeutic Environment

D. Physiological Integrity

The nurse promotes physical health and wellness by providing care and comfort, reducing client risk potential, and managing health alterations.

1. Basic Care and Comfort—Providing comfort and assistance in the performance of activities of daily living. Related content includes but is not limited to:

■ Assistive Devices
■ Elimination
■ Mobility/Immobility
■ Non-Pharmacological Comfort Interventions
■ Nutrition and Oral Hydration
■ Personal Hygiene
■ Rest and Sleep

2. Pharmacological and Parenteral Therapies—Providing care related to the administration of medications and parenteral therapies. Related content includes but is not limited to:

■ Adverse Effects/Contraindications/Side Effects/Interactions
■ Blood and Blood Products
■ Central Venous Access Devices
■ Dosage Calculation
■ Expected Actions/Outcomes
■ Medication Administration
■ Parenteral/Intravenous Therapies
■ Pharmacologic Agents/Actions
■ Pharmacological Pain Management
■ Total Parenteral Nutrition

3. Reduction of Risk Potential—Reducing the likelihood that clients will develop complications or health problems related to existing conditions, treatments, or procedures. Related content includes but is not limited to:

■ Changes/Abnormalities in Vital Signs
■ Diagnostic Tests
■ Laboratory Values
■ Potential for Alterations in Body Systems
■ Potential for Complications of Diagnostic Tests/Treatments/Procedures
■ Potential for Complications from Surgical Procedures and Health Alterations
■ System Specific Assessments
■ Therapeutic Procedures

4. Physiological Adaptation—Managing and providing care for clients with acute, chronic, or life-threatening physical health conditions. Related content includes but is not limited to:

■ Alterations in Body Systems
■ Fluid and Electrolyte Imbalances
■ Hemodynamics
■ Illness Management
■ Medical Emergencies
■ Pathophysiology
■ Unexpected Response to Therapies


Licensing Examination


The five phases of the nursing process are equally important. Therefore, each is represented by an equal number of items on the NCLEX-RN and all are integrated throughout the exam. In this book, you will have opportunities to respond to questions involving all five steps of the nursing process.

Licensing Examination: Caring

Focus topic: Licensing Examination

The caring process refers to interaction between the nurse, client, and family in a way that conveys mutual respect and trust. The nurse offers encouragement and hope to clients and their families while providing nursing care. Questions about the caring process are threaded throughout the licensing exam to test the candidate’s attitudes and values for caring for and about clients. In this book, you will have the opportunity to respond to questions that test your ability to apply the caring process in a variety of situations.

Licensing Examination: Communication and Documentation

Focus topic: Licensing Examination

Another element of the licensing exam test plan evaluates the nurse’s ability to communicate with clients, families, and health team members. The test also includes questions about documenting nursing care according to standards of nursing practice.In this book, you will be presented with questions that ask you to determine the most effective way to communicate with clients, families, and other health professionals. You will also have the opportunity to respond to questions that require you to select the appropriate information to document or chart.

Licensing Examination: Teaching/Learning

Focus topic: Licensing Examination

An important aspect of nursing care is to teach clients and their families about managing their own health status. Nurses also teach other members of the health care team. Questions in this book are designed to assist you in answering questions about the teaching and learning process for a variety of clients and health care team members.

Exam Administration

Focus topic: Licensing Examination

Licensing Examination: Computer Adaptive Testing

Focus topic: Licensing Examination

The NCLEX-RN is administered using computer adaptive testing (CAT) procedures. CAT uses the memory and speed of the computer to administer a test individualized for each candidate. When the examination begins, the computer randomly selects a question of medium difficulty. The next question is based on the candidate’s response to the previous question. If the question is answered correctly, an item of similar or greater difficulty is generated; if it is answered incorrectly, a less-difficult item is selected. Thus, the test is adapted for each candidate. Once competence has been determined, the exam is completed at a passing level.

CAT has several advantages. For example, an exam can be given in less time because candidates potentially have to answer fewer questions. CAT exams also can be administered frequently, allowing a graduate of a nursing program to take the exam following graduation, receive the results quickly, and enter the work force as a registered nurse in less time than is possible with paper-and-pencil exams. Study results also show that, because CAT is self paced, candidates undergo less stress.

Each NCLEX-RN test is generated from a large pool of questions (a test item bank) based on the NCLEX-RN test plan. The test item bank includes all types of questions, but an individual candidate may or may not receive each type of question, depending on the questions generated from the item bank for each candidate. The exams for all candidates are derived from the same large pool of test items. They contain comparable questions for each component of the test plan. Although the questions are not exactly the same, they test the same knowledge, skills, and abilities from the test plan. All candidates must meet the requirements of the test plan and achieve the same passing score. Each candidate, therefore, has the same opportunity to demonstrate competence. Although one candidate may answer fewer questions, all candidates have the opportunity to answer a sufficient number of questions to demonstrate competence until the stability of passing or failing is established or the time limit expires.

All candidates must answer at least 75 test questions; the maximum number of questions is 265. Each exam also includes 15 “pretest” questions that are being tested for use on subsequent exams. Candidates cannot differentiate “pretest” items from operational items on the exam.

Six hours are available to each candidate for completing the test. This time includes an opportunity to review the online candidate tutorial about the test and to take rest breaks. Although some candidates may finish in a shorter time, others will use the entire 6 hours. The amount of time used during testing is not an indication of passing or failing the examination, but rather, reflects the time required to establish competence for each candidate.

Licensing Examination: Scheduling the Examination

Focus topic: Licensing Examination

The first step you must take to schedule your NCLEX-RN exam is to apply to the state board of nursing in the state in which you plan to take the examination. After receiving confirmation from the state board of nursing that you have met their requirements, you will then receive an Authorization to Test (ATT). Registration for the exam with Pearson VUE ( can be done by mail or online, and confirmation of registration should occur within several days, or immediately if done online. ATT is valid for a specified period of time; check with your state board of nursing for their specific requirements. After receiving the ATT, you can schedule an appointment to take the exam. Check for current information at the NCSBN web site ( and the web site of your state board of nursing. (See the appendix for State and Territorial Boards of Nursing.) Scheduling to take the examination at an international test center requires additional steps and fees; consult the web site of the NCSBN for current information.

Licensing Examination: Test Center Locations

Focus topic: Licensing Examination

The Council of State Boards of Nursing contracts with vendors in each state to serve as exam sites. Your school of nursing can inform you of the nearest location. You can also contact your state board of nursing for information. (See the appendix for State and Territorial Boards of Nursing for the address.) You can also find updated information from the NCSBN at its web site (

Licensing Examination: Computer Use and Screen Design

Focus topic: Licensing Examination

Test questions are presented on the computer screen (monitor); you select your answer and use the keyboard or a mouse to enter your answer. The CD-ROM included with this book simulates the NCLEX-RN and provides you with an opportunity to practice taking computer-generated examinations. At every testing site, written directions are provided at each computer exam station. There are also tutorials and practice questions on the computer that you can complete to be sure you understand how to use the computer before you begin the exam.

The computer used at the testing site has a drop down clock that indicates elapsed time for taking the exam. This clock can be turned “off” or “on” depending on your preference. Some test-takers wish to watch the time as they take the test; others wish to monitor their time periodically. When the exam ends, there will be a message on the screen that indicates “Examination is ended.”

The computer used at the testing site also has a drop-down calculator. The calculator can be used to answer test items requiring calculation. You can use the mouse to drag the calculator to a position on the screen where it is most helpful to you.

Licensing Examination: Exam Security

Focus topic: Licensing Examination

Each testing site maintains a high level of security for the exam and for the candidate. The exam is administered on a secured file server and uses password security and host site authentication. All exam sites use proctors and video/audio monitoring. Candidates are required to undergo identification verification, which includes showing a valid and recent photo ID (driver’s license or passport— passport required at international test centers) with signature (the name must match exactly the name on the Authorization to Test), fingerprint testing, or providing a digital signature. Some sites are also using a palm vein reader and/or other biometric tests. Check with your state board of nursing and the NCSBN for details about exam security in the jurisdiction in which you are taking the exam.

Licensing Examination: Exam Confidentiality

Focus topic: Licensing Examination

The NCSBN takes significant steps to protect exam confidentiality. You will not be allowed to bring anything into the exam area, including cellular telephones, watches, handheld electronic devices or paper, or pen/pencil into the exam. While taking the exam, you are not allowed to give or receive test- taking assistance and you cannot review study materials during a break from the exam; a proctor will be monitoring these areas. Additionally, you will be asked to sign a confidentiality agreement that you will not share information about the test or the test items with others.

Licensing Examination: Special Accommodations

Focus topic: Licensing Examination

Special accommodations for ADA candidates can be made with authorization from the individual state board of nursing and the NCSBN. To be eligible for special accommodations, the candidate must have a professionally recognized diagnosis and documentation with recent test results and evaluations. If approved, the accommodations will be noted on the ATT and implemented at the testing center. Check with your state board of nursing for additional information.


Licensing Examination: The Test Center

Focus topic: Licensing Examination

Although each test center is configured differently, each center will have a small waiting area, a registration area, and a proctored testing area; lockers are provided for valuables. Since the waiting area is small, you should advise your friends and/or family to return to the test center when you have completed the exam.

You should arrive at the test center 30 minutes before you are scheduled to take the test. You should bring your Authorization to Test (ATT) and two forms of identification with you, one of which has photo identification. Leave all unnecessary items in your car or with friends or family. When you resister at the test center, the test center staff will obtain your fingerprint and digital signature, and as available, a palm vein reading. At this time you will also lock any valuables and electronic devices in a locker. No watches, pencils, or cell phones will be allowed in the test taking area.

Licensing Examination: Taking the Exam

Focus topic: Licensing Examination

Once you have entered the testing area and have settled comfortably at the desk, the proctor will turn the computer on. You may request ear plugs if the noise of other test-takers using the computers in the area is distracting. Each test area has an erasable note board with a marking pen which may be used to make notes or perform math calculations. Before the actual exam begins, there will be an online tutorial that gives you information about the exam and provides an opportunity to practice using the keyboard, mouse, and calculator. Previous computer experience is not necessary to take the NCLEX-RN exam.

You will begin the exam after completing the tutorial. The test questions are presented on the computer screen. You should answer each question; the next question will not appear until you have submitted an answer to the question on the screen. There is no penalty for guessing, but you should make a reasonable attempt to answer the question correctly.

As you progress through the test, pace yourself. You should answer the questions at a comfortable speed, not spending too much time on any one question. There is a clock on the computer which can be turned off or on. Some students prefer to turn the clock on periodically rather than watching the time on the clock and feeling rushed. The clock will appear during the last 5 minutes of the test. You may take a break as needed. The proctor will escort you to the restroom; biometric identification (fingerprint, palm vein reading) will be obtained on your return to the computer desk.

Once you have answered a sufficient number of questions to determine if you have passed or failed the test, or if the allotted time (6 hours) has ended, the exam will end. You will be asked to take a survey about the test experience following the exam, and when you are finished you can raise your hand to indicate to the proctor that you are finished. The proctor then will collect all items at the desk and escort you to the exit.

Licensing Examination: Results Reporting

Focus topic: Licensing Examination

Computerized testing allows timely reporting of examination results. The results of the examination are first reviewed at the testing site and then forwarded to the state board of nursing within 8 hours. Results are reported to the candidate within 2 weeks. Some jurisdictions have “quick results” services; for a fee, the candidate can obtain “unofficial” results by internet or a 900 number telephone call.

The exam can be retaken within 45 days. Check with your state board of nursing for details. (See the appendix for a listing of state boards of nursing.)










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