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Preparing For The NCLEX Exam

The National Council Licensure Examination (NCLEX) is a standardized nursing licensure examination developed by the National Council of State Boards of Nursing, Inc. (NCSBN). Currently, this exam is offered in a computerized format. Passing the NCLEX is necessary for licensure for all practical and registered nurses. After completing an accredited nursing education program, this exam is the deciding factor in whether or not an individual can become licensed to work as a nurse in the United States. Due to the importance of this exam to one's career, the NCLEX should not be taken lightly. There are many resources available to help potential nurses to be prepared and succeed in passing this exam.

Studying for the NCLEX-PN or NCLEX-RN

The key to passing the NCLEX is preparation. Candidates should study nursing materials thoroughly with additional emphasis on difficult topics. It is important to review information until the individual fully understands each topic, rather than memorizing and regurgitating questions and patterns. It may help to explain the material to another person, as teaching others can help one to develop a better understanding of a topic.

When preparing for the NCLEX, candidates should study a variety of materials. Textbooks and lecture notes are valuable tools, as are past exams and coursework. Individuals are also encouraged to obtain an NCLEX preparation book. It may be helpful to research these books prior to buying and to purchase one that has received good reviews from previous test-takers. In addition, some nursing programs offer NCLEX preparation courses similar to those offered to prepare students for the SAT. These courses will give candidates an opportunity to review potential NCLEX questions in a group, with the help of a facilitator.

When it comes to studying alone or in a group, there is no right and wrong approach. Candidates should use the study methods that work best for them. For some, this means studying alone in a quiet, comfortable environment that is free of distractions. Others learn well in a group environment where they are able to ask questions and take turns explaining topics to one another. If one chooses to participate in a study group, it is important to stay on topic and keep personal conversations to a minimum. The downside to studying with others is that these meetings can quickly turn from academic to social.

NCLEX Structure and Topics

According to the NCLEX-RN Test Plan and the NCLEX PN Test Plan provided by the NCSBN, the NCLEX is structured around four main categories of Client Needs.

It is difficult to predict what exactly will be on the exam because the exact content is unique for each test-taker. For practical/vocational nurses, between 85 and 205 items must be answered within 5 hours. Registered nurses have 6 hours to complete the NCLEX, and must answer between 75 and 265 questions. For this reason, the NCSBN only estimates the weight of each section on the exam. The test plans are released every three years to include updated information. Candidates should view the test plan for a more detailed breakdown of test content.

The NCSBN determines the percentage of categorical questions. These questions combine analytical and application-related questions to test the candidate’s clinical knowledge of each patient situation. The categorical percentages change in accordance with 130 activity statements. The NCSBN's test format (computerized adaptive testing) generates questions based on the test-taker’s previous answers. The computer analyzes the candidate's knowledge of the subject to determine the next question. The computer will stop asking questions when the test-taker answers a certain amount of difficult questions correctly. The candidate must remain above the passing standard on the last 60 questions answered.

The NCLEX is structured around the following categories and subcategories:

  • Safe and Effective Care Environment (Coordinated Care for NCLEX-PN)
    • Management of Care: This subcategory includes a variety of topics that are related to the safety of clients/patients and healthcare staff. Some of these topics include advocacy, case management, ethical practice, confidentiality, and patient rights.
    • Safety and Infection Control: This category relates to injury and disease prevention. Some examples of the topics covered include injury prevention, incident reporting, standard and transmission-based precautions, and use of restraints.
  • Health Promotion and Maintenance: This category includes a variety of questions related to human development and the detection of health conditions. It includes topics such as aging, disease prevention, and health screening.
  • Psychosocial Integrity: This category of questions relates to the psychological health of patients/clients. It includes topics such as abuse and neglect, crisis and behavioral intervention, and therapeutic communication and environment.
  • Physiological Integrity
    • Basic Care and Comfort: This topic is centered on daily care tasks, including assistive devices, mobility, and personal hygiene.
    • Pharmacological and Parenteral Therapies: This category is made up of questions that deal with topics related to administering medication as well as parenteral nutrition.
    • Reduction of Risk Potential: The questions in this category are related to preventing complications as a result of treatment and health conditions. Some of the topics covered include diagnostic tests, potential for complications, and changes or abnormalities in vital signs.
    • Physiological Adaptation: This section is made up with questions related to caring for patients with acute, chronic, or potentially fatal illnesses. The topics include illness management and medical emergencies, along with other related subjects.

Preparing for Test Day

Leading up to the exam, candidates should continue their usual routine, making plenty of time to study. Individuals are encouraged to eat well, exercise, and get plenty of sleep, as taking care of oneself is a great way to combat stress.

The best way to avoid test stress is to be adequately prepared. Candidates who have studied thoroughly and know the material should be able to approach the NCLEX with confidence. Preparation does not guarantee success on the exam, but it greatly decreases one's chance of failing. Having a positive attitude and feeling ready for the exam is likely to improve the NCLEX experience. If necessary, it might help to practice some relaxation techniques.

Candidates may experience test anxiety on the day of the exam, but there are ways to ward off nerves. One way to do this is to control the things one is able to control. Individuals should know where the test site is in advance or have printed directions, and they should plan for traffic or other delays. Getting to the test site early will reduce the added anxiety of running late. In addition, candidates should have all necessary items ready the evening before the exam (identification, authorization to test (ATT), etc.) to avoid forgetting something and being unable to take the test at the scheduled time. In addition to the items necessary for testing, candidates who are often cold may wish to grab a jacket or sweater to ensure comfort during the test.

Before leaving for the exam, candidates should eat a nutritious, protein-rich meal that is low in sugar or processed carbohydrates. Doing so will keep one full and focused during the exam. It is important to avoid sugary, carbohydrate-rich foods because eating these items leads to a spike in blood sugar and a crashing, drowsy feeling later. Those who become jittery or anxious when they consume caffeine may wish to avoid coffee and other beverages containing this substance.

After arriving at the testing center, candidates should try to relax. Using techniques such as deep breathing exercises, reading something enjoyable, or listening to calming music is a great way to do so. Cramming directly before the exam is not advised because it can cause confusion. Instead, individuals should be confident that they have done their "homework" and that they are ready for the challenge ahead. Focusing on the reward associated with passing the NCLEX and becoming a licensed nurse may aid in relaxation.

Taking the Exam

As previously mentioned, practical/vocational nurses have five hours to complete the NCLEX and registered nurses have six. In order to complete the necessary number of questions within the time allowed, candidates must pace themselves. It is not wise to spend an extended amount of time on a single question that one does not know the answer to. That being said, rushing through the exam is not advised. Candidates should remain calm, read each question thoroughly, use critical thinking skills, and provide the best answer.

During break, candidates may get up to stretch or walk around. Such activity helps with concentration and promotes circulation. At this time, individuals may also access their personal items and have a snack. Removing or adding layers of clothing may also help candidates to be more comfortable during this long exam.

For those who have prepared properly and know the material, envisioning the reward of becoming a licensed nurse may serve as motivation throughout the exam. The NCLEX is tough, but the sometimes unpleasant experience of standardized testing is worthwhile for a rewarding career in nursing.

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