NCLEX-RN Review & Study Guide

How to Pass the NCLEX-RN Exam On Your First Try

You’ve put in the work, gained the knowledge and skills, and earned your nursing degree. Now it’s time to put the books aside and start helping patients in the real world. There’s just one hurdle left before you can become a registered nurse — the licensing exam.

All nurses must pass the National Council Licensure Examination (NCLEX-RN) before they can work as Registered Nurses.

It’s stressful to think that passing one exam can control your future. But with adequate prep and study, you’ll have no problem passing the RN exam.

For this blog, we’ve picked the minds of our amazing Eagle Gate College instructors and combined that with tips from some recent graduates to create a comprehensive test-prep guide to help you pass the NCLEX-RN exam on your first attempt.

What Is the NCLEX-RN Exam?

The NCLEX-RN has a singular purpose: to determine if it’s safe for you to begin practice as an entry-level nurse. Unlike the knowledge-based tests you took in nursing school, the NCLEX-RN wants to see how you analyze and apply that knowledge in the real world of day-to-day nursing.

How Many Questions Are on the NCLEX-RN Exam?

The NCLEX-RN exam is a computerized adaptive exam that can consist of anywhere between 75 to 265 questions. Fifteen of those questions are experimental questions that do not count against your score; they are used to create questions for future exams.

The wide variation in test length can seem confusing. The test has an algorithm that continually tracks your answers, gauging your performance. As you accumulate more and more correct answers, the algorithm elevates your standing and at a certain point it “passes” you and you won’t have any more questions. That will be a minimum of 75 questions. The flip side is also true; if you’re missing more and more questions the algorithm may decide you are not showing the necessary competence to become a practicing nurse.

The better you perform, the fewer the questions you’ll be required to complete to pass the exam. Still, it’s a good idea to plan to take 265 questions in the full 6-hour timeframe of the test.

Most of the questions are delivered in a multiple-choice format with four answer choices. There are other question types, however, such as multiple-response, fill-in-the-blank, hot spots, charts, and drag-and-drop.

What Kind of Questions Are on the NCLEX-RN Exam?

The NCLEX-RN exam covers four areas (or categories) of questions. These are known as “Client Needs Categories.” Within two of the four categories, there are separate concepts. Let’s look at these categories and concepts here:

Safe and Effective Care Environment

The nurse promotes the achievement of client outcomes by providing and directing nursing care that enhances the care delivery setting to protect clients and health care personnel. There are two concepts within this section:

• Management of Care (17-23% of NCLEX-RN exam) — Some of the nursing actions included in this subcategory are Case Management, Quality Improvement, Continuity of Care, Informed Consent, and others.
• Safety and Infection Control (9-15% of exam) — Some of the nursing actions included here are Accident Prevention, Error Prevention, Standard Precautions, Hazardous Materials, and others.

Sample Question #1: The nurse has been made aware of the following client situations. The nurse should first assess the client…

• with diverticulitis who is reporting left lower quadrant (LLQ) pain
• with chronic obstructive pulmonary disease (COPD) who is reporting hemoptysis
• who had an evacuation of a subdural hematoma 8 hours ago and has become agitated
• who had a total knee replacement 8 hours ago and whose affected extremity is internally rotated

Health Promotion and Maintenance

The nurse provides and directs nursing care of the client that incorporates knowledge of expected growth and development; prevention and early detection of health problems, and strategies to achieve optimal health.

This category accounts for 6-12% of the NCLEX-RN exam. Nursing actions tested include Ante/Intra/Postpartum and Newborn Care, Disease Prevention, Health Screening, Physical Assessment Techniques, Health Promotion Programs, and more.

Sample Question #2: The nurse is teaching clients at a community health fair about risk factors for developing cancer. The nurse should recognize that at highest risk is the…

• a. 30-year-old client who consumes a diet high in selenium and has a history of an ovarian cyst
• b. 49-year-old client who drinks 2 to 3 cups of coffee daily and has a family history of fibrocystic breast conditions
• c. 51-year-old client who has hypertension and teaches an aerobic exercise program
• d. 62-year-old client who consumes 5 to 6 alcoholic beverages daily and is an opera singer

Psychosocial Integrity

The nurse provides and directs nursing care of the client that promotes and supports the emotional, mental, and social well-being of the client experiencing stressful events, as well as clients with acute or chronic mental illness.

This category accounts for 6-12% of the exam. Tested nursing actions include Coping Mechanisms, Mental Health Concepts, Sensory/Perceptual Alterations, Stress Management, Chemical Dependency, Crisis Intervention, Family Dynamics, and others.

Sample Question #3: The nurse is talking with a client who had a colostomy created 2 days ago. Which of the following statements by the client would indicate ineffective coping? Select all that apply.

• a. “I am not touching that disgusting bag.”
• b. “I am glad I can still go to the gym just as I used to.”
• c. “I really like raw vegetables, and it will be hard for me to limit them.”
• d. “I understand the need for the colostomy, but I am afraid that the bag will leak.”
• e. “I do not understand why I cannot have a nurse perform the colostomy bag changes for me.”

Physiological Integrity

The nurse promotes physical health and wellness by providing care and comfort, reducing client risk potential, and managing healthy alterations. This category is broken into four concepts:

1. Basic Care and Comfort (6-12% of the exam) — Nursing actions included in this subcategory are Assistive Devices, Elimination, Mobility, Nonpharmacological Comfort Interventions, Personal Hygiene, and others.
2. Pharmacological and Parenteral Therapies (12-18% of the exam) — Tested nursing actions include Contraindications, Blood and Blood Products, Chemotherapy, Intravenous Therapy, Medication Administration, Dosage Calculation, and others.
3. Reduction of Risk Potential (9-15% of the exam) — The tested nursing actions include Diagnostic Tests, Laboratory Values, Potential for Complications from Surgical Procedures and Health Alterations, and others.
4. Physiological Adaptation (11-17% of the exam) — Tested nursing actions include Alterations in the Body Systems, Fluid and Electrolyte Imbalances, Medical Emergencies, Pathophysiology, and others.

Sample Question #4: The nurse is teaching a client who had a subtotal gastrectomy about ways to prevent dumping syndrome. Which of the following foods would be appropriate for the nurse to recommend to eliminate from the client’s diet?

1. Cheese
2. Red Meat
3. Ice Cream
4. Yellow Vegetables

Answers: 1)C 2)D 3)A&E 4)C

Is the NCLEX Exam Hard?

The difficulty of the NCLEX exam is also based on your performance. By doing well on the exam, the questions will grow more challenging. Answering more and more of these increasingly difficult questions correctly will also decrease the number of questions you have to answer. If the questions do remain simple, it may indicate that you are not answering enough questions correctly.

How Long Is the NCLEX-RN Exam?

You are allotted a total of 6 hours to complete the NCLEX-RN exam, regardless of the number of questions you’re given.

Prior to taking the exam, you’ll be presented with a short instructional video.

During the exam itself, you will be granted two optional breaks:

• One break is available 2 hours into the exam.
• A second break can be taken after 3.5 hours into the exam.

Once you’ve answered the minimum number of questions required to pass the NCLEX exam, the test will automatically stop on its own.

What Is the Passing Score for the NCLEX-RN Exam?

While there isn’t a set number of questions you must answer correctly to pass the NCLEX exam, you will pass the test if you answer enough questions to stay above the “pass” line with a 95% confidence interval.

How Many People Pass the NCLEX-RN on Their First Try?

According to the NCSBN, around 79% of all candidates passed the NCLEX-RN exam on their first attempt in 2021.

With initial passing rates of almost 8 in 10 candidates, there’s no reason you can’t be a part of those high-flying numbers in next year’s statistics.

How Do I Register for the NCLEX-RN Exam?

Once you’ve completed a nursing program, we recommend you take a week or two to relax and enjoy your free time before registering for the NCLEX exam.

Nursing school can take a lot out of you, and you’ll need to recuperate both mentally and physically before studying for the exam.

Once you feel ready, you can schedule your exam by registering with Pearson VUE for an Authorization to Test (ATT). We recommend you schedule your test date a couple of months out to give yourself enough prep time before taking the exam.

7 Simple Steps to Register for the NCLEX-RN Exam

The official steps to register for the NCLEX-RN exam are as follows:

Step 1:

Submit an application for licensure/registration to the nursing regulatory body (NRB) where you wish to be licensed/registered.

Step 2:

Meet all of the NRB’s eligibility requirements to take the NCLEX exam.

Step 3:

Register for the NCLEX with Pearson VUE.

Step 4:

Receive NCLEX Registration Acknowledgement email from Pearson VUE.

Step 5:

Confirm NRB eligibility in the Pearson VUE system.

Step 6:

Receive Authorization to Test (ATT) email from Pearson VUE.

Step 7:

Schedule your exam with Pearson VUE.

How Much Does the NCLEX-RN Cost?

It costs $200 to take the NCLEX-RN exam.

There may be additional licensure fees that are determined by the individual State Boards of Nursing. You can pay this fee online or over the phone using a credit, debit, or prepaid card.

How Do I Study for the NCLEX-RN Exam?

There’s no right or wrong way to prepare for this exam. It’s likely to be different from any other test you’ve taken previously (other than the practice NCLEX tests, of course). The important thing is to put in the time you need to be ready.

There are lots of online resources, practice questions, and study guides that can provide you with the tools you need to pass the NCLEX-RN.

To make your life easier, we’ve created a list of the top five test prep tips that will help you pass the NCLEX-RN on your first attempt.

Tip #1: Understand the NCLEX-RN Exam Format

Before taking the exam, you’ll need to familiarize yourself with the exam format to avoid being surprised when you show up to the test.

We’ve provided you with an overview of the NCLEX format, but for more in-depth information, check out the 2022 NCLEX Candidate Bulletin.

Tip #2: Create a Personalized Study Plan

You may have gotten away with last-minute cramming at other points of your educational path but preparing to take the NCLEX-RN demands a plan. It’s a good idea to designate the days of the week you want to study, along with how much time you plan to spend studying.

To get the most out of these sessions, they should be at least two hours long. Of course, if you’re rolling, there’s no reason to knock off at your allotted time. More preparation will definitely not hurt you come test day.

Tip #3: Take the NCLEX Practice Exams

You’ll want to schedule at least two NCLEX practice tests before sitting for the real exam.

You can register for the practice exams directly through this link to the NCLEX Practice Exam landing page.

These practice exams familiarize you with the computer testing experience of the NCLEX-RN. Plus, seeing these practice exams lessens your stress level when you’re facing the actual NCLEX-RN. You’ll also see the questions you’re missing, and you can adjust your preparation in those areas as needed.

Tip #4: Have a Test Day Game Plan to Help Manage Stress

As with any standardized test, there are simple tips and techniques you should follow to give you a better shot at passing the NCLEX exam.

By familiarizing yourself with the NCLEX format, you won’t feel as much pressure on test day. For example, you will already know that if the questions are becoming more difficult, then it’s likely you’ve answered many of the previous questions correctly.

It’s also important to remember that the exam ranges between 75 and 265 questions, so you’ll be running a marathon, not a sprint. Be sure to take the allotted breaks during the test. This time lets you clear your head for a few minutes, use the bathroom, and eat or drink something light.  

Tip #5: Prepare for Exam Day

You’ve recently finished nursing school, so you know how best to prepare for an upcoming test. The NCLEX is no different. Go to bed early the night before the test. On the morning of the exam, it’s important to eat breakfast. This test can be as long as a 6-hour slog, and you don’t want to go into it on an empty stomach. You’ll need the energy to stay fresh and sharp throughout the testing period.

For your convenience the NCSBN offers several NCLEX-RN tips for exam day:

Be Prepared

When you arrive for your NCLEX, you’ll need an acceptable form of ID. You no longer need to bring a paper copy of the Authorization to Test (ATT) for admittance to the NCLEX. For further details, please visit Authorization to Test.

Don’t Forget Your ID.

Candidates without proper ID will not be allowed to take the NCLEX.

Know the NCLEX Candidate Rules!

These include policies specific to personal items, confidentiality, NCLEX administration, and break procedures.

Dress Comfortably.

You’re required to leave hats, scarves, gloves, and coats outside the testing room. However, provisions are made for religious and cultural attire.

Arrive Early.

Plan to arrive 30 minutes before your exam. If you are more than 30 minutes late, you may have to forfeit, re-register, and pay another exam fee.

Provide Your Biometrics.

In order to be tested, the following biometrics will be taken: signature, photograph, and palm vein scan.

Receive Materials.

You may not bring in paper or writing utensils. It is a computer-administered exam. However, you will be provided an on-screen calculator and an erasable note board/marker for making notes.

Set Your Pace.

You’ll have up to 6 hours to complete the NCLEX-RN. There is a short tutorial at the beginning. Breaks are not mandatory, but we highly recommend them. The first optional break comes after 2 hours of testing, with the second break coming after 3.5 hours of testing. Take time to analyze each question carefully — once you submit an answer you can’t return to that question. Learn more about computer adaptive testing (CAT) here.

Finishing Up.

At the end of the exam, you will receive a short, computerized survey. Upon completion, you can raise your hand and wait for the TA to dismiss you.

What to Do After the NCLEX Exam?

Exam results are available only from your nursing regulatory body (NRB) and will be sent to you approximately six weeks after taking the exam.

How to Retake the NCLEX-RN Exam?

If you don’t pass the NCLEX exam on the first try, you can always retake it.

Fortunately, the NCSBN provides a performance report from the exam, allowing you to see where you struggled and where you need to improve before your next attempt.

To retake the exam, you’ll contact your NRB and notify them you plan on retaking the exam. You will simply re-register with Pearson VUE, pay the $200 fee, and wait to receive your new ATT to schedule your exam.

How Many Times Can You Fail the NCLEX-RN?

If you don’t pass the NCLEX-RN the first time, you’ll have plenty of chances to upgrade your preparation and take it again. Candidates can take the NCLEX up to eight times a year. The NCSBN requires that you wait at least 45 days between exam attempts. To be certain, contact your desired nursing regulatory body to learn more about their policy for NCLEX-RN retakes.

Advancing Your Career as a Registered Nurse

We hope you found this article helpful and that you’ll be able to use this information to help you pass the NCLEX-RN.

Rather than looking at the NCLEX-RN as an obstacle, we prefer our Eagle Gate students to think of it as affirmation. Passing this detailed and extensive examination proves to the world what you’ve known all along — that you’re ready to help patients and enjoy your new career as a registered nurse.

Nursing has always been a noble profession. Becoming a registered nurse can open doors to lots of opportunity, including career specialization, high earning potential, and a great job outlook.

If you’re ready to take the first step towards a future nursing career, you can start by earning your Bachelor of Science in Nursing degree at Eagle Gate College.