NCLEX-RN® Exam: What to Expect and How to Study

• The NCLEX-RN® exam can feel daunting, but we’re here to help you pass with flying colors. 
• RN candidates will have to answer at least 85 questions in various item types, with three full case studies. 
• In 2023, with the introduction of the Nex-Gen NCLEX®, a clinical judgment section was introduced to the NCLEX-RN® exam. 

The NCLEX-RN® exam can be terrifying, daunting, and overwhelming. But we’re here to help you feel comfortable, prepared, and ready to take that exam by the horns and pass with flying colors.  

Let’s start with the details of the exam and what it entails.  

NCLEX-RN® Exam Format and Updates

All registered nurse (RN) candidates will have a minimum of 85 questions in various item types, with three full case studies. The maximum number of questions an RN candidate can have is 150 with a variety of item types and three full case studies.  

A candidate has up to five hours, including breaks, to take the NCLEX-RN® exam. If you were granted additional time for accommodation in school, make sure you have the same accommodation for this exam. To request accommodation, you’ll have to go through your state’s nursing review board. 

The NCLEX® tests over specific categories. Its eight client need categories are: 

• Management of Care. 
• Safety and Infection Control. 
• Health Promotion and Maintenance. 
• Psychosocial Integrity. 
• Basic Care and Comfort. 
• Pharmacological and parenteral Therapies. 
• Reduction of Risk Potential. 
• Physiological Adaption. 

In 2023, with the introduction of the Next-Gen NCLEX®, a clinical judgment section was introduced. 

Clinical judgment is a substantial portion of professional nursing and is the result of critical thinking and decision making. It is a process that first recognizes cues, then analyzes those cues, prioritizes hypotheses made from those cues, generates solutions to those hypotheses, takes action while prioritizing the most important client needs first, and finally, evaluates the outcomes of those actions.  

Another major change that coincided with the 2023 Next-Gen update was the introduction of new item types. The traditional item types are multiple choice, select all that apply, hot spot, fill-in-the-blank (numerical), drag and drop ordered response, chart/exhibit/graphics questions, and audio questions.  

The new item types seem a bit more complex, but that’s mostly because they are new and not as familiar as the traditional item types. The Next-Gen item types are extended multiple response, matrix grids, drag and drop, drop down, highlight, bowtie, and unfolding case studies. Slone NCLEX features all of these item types in its NCLEX® prep program.  

The exam is administered through computer-adaptive testing, meaning that the computer adjusts the difficulty of questions based on your answers to previous questions. Once a tester is above or below the passing standard at a certain level the test will shut off, the exam is scored, and a pass or fail is sent to the tester’s nursing review board to be sent to the tester.  

Another change was updated scoring that now ensures partial credit is given to multiple part questions. There are four types of scoring models used in the NCLEX-RN® exam. There is partial credit scoring for items for which more than one key exists. There will be three methods for scoring items for partial credit: plus/minus, zero/one, and rationale scoring.    

How to Study 

All right, now that you understand what the NCLEX® is and what to expect, let’s talk about how you can study.

The most important thing you can do is take as many NCLEX®-style questions as you can in various categories and item types. Your goal should be to take at least 200-400 questions per day until exam day. You should also use a prep program like Slone NCLEX to keep your preparation organized and structured.

It is so hard to stay focused and maintain the rigor of nursing school with NCLEX® prep after you graduate, but it is needed for you to be successful. So, find a reputable prep program that provides quality questions, detailed rationales, and readiness exams to gauge your progression and exam readiness. And stick to it!

When answering questions, remember that the entire purpose of the exam is to test your ability to be a SAFE practicing entry-level nurse. After reading questions on the exam, determining which possible answer ensures your client is SAFE, which promotes their safety, and how do I ensure they have safe outcomes?  

On the questions where you’re at a loss, look at the answer options and see if you can find a common denominator. Or, do all but one option seem negative? This can help you pick an option.  

The Bottom Line 

Before you start the exam, take three deep breaths. Deep breathing can help you improve focus, reduce anxiety, and help you manage the stress of the exam. If you begin getting worked up during the exam, pause and take a deep breath, it sounds simple, but it will be a huge help! 

Most importantly, believe in yourself. Remember that you’ve got this, you can do this and that we’ve got you! 

Begin your NCLEX® preparation journey with Slone NCLEX today.