Andrea Clement

Healthcare writer, career columnist. PR / media rep. Freelance writer, essayist.

Jun 28, 2021
4 min read

If you are planning for your NCLEX — National Council Licensure Examination — you are likely nearing the end of your nursing school journey and will soon complete the process of becoming a registered nurse.

The NCLEX-RN exam is the final hurdle to embarking on your career as a nurse. Therefore, after all you’ve already accomplished in nursing school, you may be experiencing some anxiety about the test. There is a lot of built-up pressure, and you may want to know more about how, when and where to begin studying and preparing for the test.

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Many experts say the test is changing continually and is different for everyone — therefore, it is unlikely any two prospective nurses will have the same test experience or questions.

Additionally, most nurses advise structuring your studying in a way that is comfortable for you, but is consistent and ongoing up until a day or two before the test, when it’s recommended that you give your brain a break from studying. In other words, last-minute cramming for the NCLEX is not advisable or effective.

What can you expect on test day?

“The testing center is quiet — quieter than a library — and the testing process can feel a bit awkward,” explained Marcia Sotelo, DNP, RN, CNE, CTN-B, Nursing Department chair for American Public University System.

“When testers first arrive for the test, they will be asked to show a photo identification and then lock up all of their belongings in one of the provided lockers. Entering and exiting the testing room will require the use of a fingerprint (or palm print). For test takers who are likely quite anxious, this procedure can make them feel ever more anxious,” Sotelo continued. “I highly suggest viewing the exam day information on the NCSBN.com website. The National Council of State Boards of Nursing is responsible for the ongoing development of the NCLEX exam.”

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How is the test structured?

By design, the NCLEX is probably unlike any other test you have ever taken.

“The NCLEX, more than ever before, is reflective of the clinical judgment nurses need to possess to safely practice nursing,” stated Ann Dabrow Woods, DNP, RN CRNP, ANP-BC, chief nurse of health learning, research and practice for Wolters Kluwer. “The National Council of State Boards of Nursing continually evolves the exam to mirror evidence-based practice changes in nursing,” she added.

“When it comes to the actual structure of the exam, it is mostly made up of multiple-choice questions, although other formats may be included,” said Dabrow Woods, who also serves as adjunct faculty of the graduate nursing program at Drexel University. “The exam is personalized to the test taker’s performance, meaning it follows a variable question format in which the computer adapts to provide increasingly difficult questions as time goes on. The exam will continue until the person being examined reaches 95% certainty of a passing score.”

“The NCLEX uses a CAT format (computerized adaptive testing) that is very different from a typical exam,” Sotelo concurred. “The computer ‘adapts’ the questions based upon the tester’s answers, selecting questions at a difficulty level where the tester has a 50% chance of answering correctly.”

“After every question, the computer reevaluates the tester’s ability, and again chooses a question it believes the tester has a 50% chance of answering correctly,” Sotelo explained. “When testers answer questions correctly, they receive more challenging questions. When testers answer questions incorrectly, they receive less challenging questions. Either way, testers must understand and be prepared for this new type of testing and have a mindset that they are likely to be answering questions that are difficult for them. A clear understanding of this testing format can help prevent the anxiety that occurs when a tester is struggling to consistently provide correct answers to questions,” added Sotelo.

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Scheduling tips: timing of test and when to register

Experts agree the timing of the test is important, and you should register to take the exam as soon as possible, while nursing school information is still fresh.

Tracy Jones-Darnell, EdD, MSN, RN, CNE, NE-BC, faculty member for Walden University’s RN-BSN program, explained that “a student cannot register for the NCLEX until they get an ATT, which is an authorization to test, from their state.”

Her research and observations regarding the ideal time frame has found that “students are most successful if they test within eight weeks of graduation. Many students feel they are already prepared and do not need to study that long and test much sooner,” she continued. “There is not a magic window of time, but the longer you wait past the eight-week window, the greater your chance of not passing the NCLEX on the first attempt.”

Tammy Bjork, ADN, RN, NCLEX tutor for Amarillo College, suggested that prospective nurses “take your exam at the time of day that you test best. If you are a morning person and you do well early in the morning, then schedule your NCLEX for that time. If afternoon testing is your best time, then go for it.”

“‘Cramming’ for the NCLEX is impossible,” Sotelo added. “There is simply too much information that is covered on the exam (e.g., all body systems, all medications, all nursing interventions, etc.). Successful students are those that set a schedule for some studying every day — and stick to that schedule.”

Study tips from nurses

“My recommendation is to devote around two hours a day to studying and develop a study plan that works for you. Use a mix of learning styles … whether it is hands-on, visual, auditory or a combination of those. Using different styles will help retain more knowledge,” Dabrow Woods suggested. “Some tried-and-true methods for retaining information are mnemonics, drawing out concepts or relationships, using the teach-back method where you teach someone else about concepts and applications, or use flash cards.”

Bjork warns against studying right up until the test time. “The brain gets exhausted! You want to go into an exam with your mind alert and ready to use. So, the best thing you can do is to take a break, go for a walk, and breathe in fresh air. Prepare your mind for the challenge ahead by taking a moment to relax. Cramming is the brain’s enemy.”

Sotelo emphasized that studying is ongoing throughout nursing school and never ends. “The most important thing is to not stop studying. Celebrate graduation from nursing school the day of the graduation ceremony. The next day, students need to continue to study. … Students don’t really begin studying for the NCLEX at a certain point. Rather, all their studying during their nursing program is part of the preparation for the NCLEX.”

Sean Marchese, MS, RN, passed the NCLEX in 2017 and now works as a nurse at the Mesothelioma Center. He recommends a structured but engaging approach to test prep. “Organize your study materials in a way that makes it more interesting for you to study. You don’t necessarily have to follow the structure of a study book or guide. If you don’t want to learn all of pediatrics in one afternoon, spread it across other relevant topics like nursing diagnoses or physical exam findings.”

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Mindset tactics for easing anxiety, calming fears

Dabrow Woods suggests taking control of what you can while trying not to stress about the rest. “Experts recognize that taking the exam is stressful; controlling things you can control is a good starting point to reduce the stress and anxiety levels. Small things, like filling your gas tank the night before, getting a full night’s sleep, and eating a healthy meal will put your mind at ease. I also suggest taking the day off before the exam, stop studying and practice breathing exercises to help calm your nerves.”

Marchese added, “Standardized tests can be difficult for a lot of people, but one of the most successful things a test-taker can do is change how they study, not necessarily what they study.”

“One of the strategies that helped me the most was taking time to study like it was a hobby and not a full-time job,” Marchese recalled. “Don’t pressure yourself to study all day until you reach your breaking point. Instead, put on some music or grab some snacks and study for about three to four hours every day or every other day. The trick is to start studying early enough in the season so you don’t feel like you’re running out of time.”

Tips and strategies on how to approach the questions and content

Many of the study tactics, thought processes and critical thinking skills you learned and used throughout nursing school will benefit you for the NCLEX as well.

During the exam, there are many strategies to follow, starting with examining the questions. Read the entire question and don’t jump to conclusions, determine what you are truly being asked and pull out keywords or repeated words to match the specific ask to the answers. Look for opposite answers to eliminate the wrong ones in multiple-choice questions and determine which option seems more likely,” Dabrow Woods stated. “Don’t overthink the question, and try to leave your personal experiences out of the decision making. Always reason through the questions and never second guess yourself.”

Sotelo agreed and expanded on that balanced approach of exercising caution while resisting the urge to overthink.

“Take your time, focus on one question at a time, and make sure that you are answering what is being asked. Test takers sometimes run into issues because they answer based upon their previous clinical experience (e.g., in school or working as a nursing assistant). Therefore, they may not choose the correct answer because they assume that there isn’t enough staffing, supplies, or time,” she explained. “I always encouraged students to answer the questions based on them working in what I called the ‘NCLEX Hospital.’ In this hospital, there is plenty of staff, sufficient supplies, and all the time needed. Don’t talk yourself out of the right answer.”

Jones-Darnell, who agreed with Sotelo’s advice to assume optimal hospital conditions for each question, added: “Always identify the client and issue first. Assume the client is between 18-65 years old unless otherwise stated in the question. Confirm whether the question wants you to identify something true or false, and what priority it is if they delineate a ‘first, next, before or after’ in the question. The NCBSN creates questions based on a perfect hospital setting. This means that for each question, you can assume there is always enough staffing, supplies, helpful doctors, an available pharmacist and most importantly, enough time for the nurse to perform the appropriate actions.”

Use priority frameworks

Sotelo recommends using priority frameworks for help approaching the test. A priority framework is a way of prioritizing/choosing the best answer. Sotelo provided the following examples that might be helpful as you approach the NCLEX questions.

ABCs: airway, breathing, circulation. Choose the answer that is related to airway/oxygenation. Nothing else matters if the patient isn’t able to breathe.

Maslow’s hierarchy of needs: The client must have physiological and safety needs met first.

Nursing process: The first step in the nursing process is assessment. Do you have enough information — based on the stem in the question — to act? If not, choose an answer that enables you to further assess.

Least restrictive, least invasive: When clients exhibit symptoms that could lead to harming themselves or others, you need to choose the least restrictive method of keeping them safe. When clients need an intervention, the safety choice is one that is least invasive and doesn’t compromise barriers between outside and inside of the body.

What if you’re not a strong test-taker?

The nursing experts consulted on this topic agree that even anxious or historically “bad” test takers can successfully pass the NCLEX, especially with appropriate preparation and mindset.

Dabrow Woods: “Nursing is a journey and you’ve already passed the first gate, graduating from school. The next step is to successfully pass the NCLEX exam and then begin onboarding and orientation. If you are not a strong test taker, don’t let that deter you or affect your performance. Instead, congratulate yourself for successfully graduating nursing school and allocate additional time to preparing for the exam. Practice tests will be key to familiarize yourself with the format of the test, and consistent studying will help prepare you for the material without burning out from long cram sessions.”

Sotelo: “The CAT format is challenging for everyone, but has been shown to be very effective in correctly determining which test takers are prepared to practice as registered nurses. Every tester receives between 75 and 145 questions and has five hours to take the exam. That means the student has over two minutes to answer each question. The best thing to do is simply focus on one question at a time.”

Lynn Weber, RN, BSN, program director of Marion Technical College: “If the student is not a strong test-taker, I would advise you to do 100 UWorld questions a day, as if you are getting in shape for the biggest competition of your life!

Jones-Darnell: “The key is to develop test taking strategies to use when you approach a question that has unfamiliar content. For those who do not test well, I suggest using these test taking strategies as they approach each question even if they think they know the answer immediately. The proprietary test reviews teach test taking strategies to assist students when answering questions on the NCLEX.”

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What not to do

Kymberlee Hardy RN, BSN, explains what to avoid before and during the NCLEX:

Do not fall into the rabbit hole of reading posts online about bad experiences of other people. Sometimes hearing what not to do is helpful, but most times it makes the test scarier than it has to be.

Do not analyze your test taking ability during the exam based on the type of questions you receive. It is common to think that “easy” questions means you are doing poorly, and “hard” questions are meant to bring your score back down, meaning you are doing well. Do not let this trip you up. Take each new question one at a time and focus on the content presented.

Do not panic when you receive another question after the “minimum question” cut off. Maintain your composure and continue testing with confidence.

More advice and anecdotes from nurses

Emily Giddings, RN, MN, CCCE: “Everyone who takes the NCLEX feels like they are failing. That’s just how the adaptive algorithm works. Every question you’re given is one the algorithm has calculated [that you’ll] have only a 50% chance of answering correctly. That means that even if I sat down to take the NCLEX again today after many years of nursing experience, I would still feel only halfway sure of every answer I give. Keep that in mind while you’re testing, and don’t let the level of difficulty cause you to lose concentration.”

Tammy Bjork: “I had a habit of putting a cinnamon Jolly Rancher in my mouth before a test because I felt that it helped stimulate my brain and it became such a habit that I could not take a test without it. In fact, my whole class started to ask for one before every test. I did the same thing before my NCLEX, and I guess it worked because I passed. Give it a try.”

Tears, emotions are normal and expected

Kymberlee Hardy, RN, BSN: “You may cry (or you may see other people outside/near the test center crying) after the exam. This is completely normal. Everyone taking the NCLEX has worked extremely hard to get to this point. Inevitably, you will think that you failed the exam once the computer shuts down. Sometimes, that is extremely overwhelming, and crying is the only way to express those emotions.”

Jones-Darnell: “Keep a positive state of mind at all times. When you allow your mind to feed on self-doubt you will create a self-fulfilling prophecy of defeat and failure. Try to remember how you arrived at this point in your life. You are smart and competent, or you would not have been accepted into nursing school and then graduated from nursing school. I advise my students to write a positive affirmation when they begin the test, such as: “I am smart! I will pass the NCLEX today!”

In closing, Jones-Darnell provided these words of wisdom about the NCLEX exam: “The world will not stop if you do not pass the NCLEX on the first attempt. In my 25 years in the nursing profession, and the last 12 in nursing education, no one has ever asked me if I passed the NCLEX on my first attempt.”

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