02.03 What is the NCLEX?
What is the NCLEX?
NCLEX (National Council Licensure Examination) is a nationwide examination for the licensing of nurses in the United States and Canada since 1994 and 2015, respectively. There are two types, the NCLEX-RN and the NCLEX-PN. After graduation from a school of nursing, one takes the NCLEX exam to receive his or her nursing license. A nursing license gives an individual the permission to practice nursing, granted by the state where he or she met the requirements (source).
Nearly 300,000 aspiring nurses take the NCLEX each year with an overall pass rate for RN candidates in 2016 of 70.18% and 70.59% for PN candidates.
Pass rates in 2016 for first time US educated tests takers was around 84%.
Goal of the NCLEX
It is the mission of the NCSBN to determine if you will be a safe entry level nurse able to think critically.
Computer Adaptive Testing
The NCLEX is administered via a computer adaptive testing mode. Essentially, in this style of testing, the computer selects the next question based on how you performed on the previous item.
According to Nursing Now, the test “compares an individual’s knowledge to a predetermined standard rather than to the performance of others who take the same test.” (source)
So let’s dive into some of the various algorithms used to deliver questions:
- Passing Standard: this is the level at which, if you score above, you receive a “passing” score, if you score below, you receive a “failing” score. Passing or failing is independent of test length or time.
- 95% Confidence Interval: the test will end when it is 95% confident that you are either above or below the “passing standard”. This is the rule that will end most tests. With each successive question, the test become more confident in your ability and your confidnece interval narrows. The image below comes from the NCSBN, the lines indicate the 95% confidence interval with the red line indicating the “passing standard”, you can see that at 60 questions, the test is 95% confident this student is below the passing standard. When it comes down to it, no matter how long your test keeps going, if it’s still going, you’re still in the game. This is why test length really doesn’t matter. What matters more is questions difficulty rating. And question difficulty is based on how you performed on the previous question. This is also the reason the number of correct answer you get really doesn’t matter all that much.
- Maximum-Length Exam Rule: you are allowed a maximum of 265 for RN and a maximum of 205 for PN.
- Run-out-of-time Rule: this rule is pretty simple, you get 6 hours to take the test. If the test is unable to determine with 95% confidence your ability before the 6 hours you will receive a failing score. If however, the test determines that your ability is above the passing standard after 6 hours you may still receive a passing score.
This is a complex algorithm and what we’ve done with SIMCLEX is strive to mimic this test setting as closely as possible, something that no other NCLEX Question Database can do.
As stated above, questions are selected based on the result of the previous question while your 95% confidence interval continues to narrow.
Aside from the criteria listed above, the test will also deliver you questions from specific nursing categories in a set distribution.
According to the most recent (2016) test plan that distribution is as follows:
Safe and Effective Care Environment
- Management of Care: 17-23%
- Safety and Infection Control: 9-15%
Health Promotion and Maintenance: 6-12%
Psychosocial Integrity: 6-12%
- Basic Care and Comfort: 6-12%
- Pharmacological and Parenteral Therapies: 12-18%
- Reduction of Risk Potential: 9-15%
- Physiological Adaptation: 11-17%
You can find the entire NCLEX Test Plan as published by the NCSBN here.
Per NCSBN Test Plan here are some examples of what will be included in each section (this outline comes directly from their test plan at the link above)
Let’s address some of the most common questions regarding the NCLEX:
- Can you skip questions?
- Will I get a test report?
- Only if you fail. If you do fail and receive a “Candidate Performance Report” use this report to restructure your studying.
- Does the NCLEX bold key words, i.e., most, priority, best, highest?
- Yes, the NCLEX bolds key words such as best, most, essential, first, priority, immediately, highest, initial, next, refute, increased, decreased and support.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell
Alright, let’s talk about what the NCLEX actually is. And by this, I mean guys, I want you to understand kinda what you’re walking into, what the NCLEX is, how it’s scored, how it works, what’s the structure of it. Because as we talked about so many times before in this course, you understand your enemy, you understand your opponent so you can be prepared for what you’re actually going into. So here’s a rickety old bridge, alright. And here’s you, and there’s RN. And in between RN and you is this pesky little thing called the NCLEX, the NCLEX. This is the test that you must pass in order to become RN. And for a lot of you right now that haven’t taken the NCLEX or have taken it and failed, you’re probably thinking this suspension bridge is over ranging rapids, and it’s a terrifying bridge that I’m not even going to think about crossing. So, I’m gonna get it out of my mind, not even worry about it, or, I’m going to think about it every single minute of every single day and stress myself to death about it. So, most people will abandon you, most people will leave you, most education companies, that is not your family and friends, of course, but most education companies leave you. And they say, you need to become an RN, you need to pass the NCLEX. But what we want to do is we’re going to make the bridge more stable, we’re gonna help you cross safely, so, you have nothing to fear. And again, the purpose of this lecture is to really help you understand what the NCLEX is and there’s a lot of extra text below in the text of this lecture. So, I really want you to read through that as well.
Every year, nearly 300,000 aspiring nurses, RN’s, PN’s, take the NCLEX with an overall pass rate for RN candidates in 2016 of 70.18% and 70.59% for PN candidates. Now, that’s for all, that’s for repeat test takers, international students, everything like that. Now, pass rates for first time US educated test takers was around 84%. So, you have an 84% chance of passing if you’re a US educated RN test taker. And about 84% for PN as well. So, the National Council Licensure Examination, that’s what NCLEX stands for. And what it is, is it’s a nationwide examination for licensing in nurses in United States and Canada, alright. Now, there’s the RN version, there’s the PN version. There’s a couple of little differences in there but we’re gonna talk mostly in this about the significant kinda points of the RN version of the NCLEX. And after graduating from nursing school, you take the NCLEX to receive your license as a nurse. Now, having the nursing license gives you, the individual, the student, now the new nurse, the permission to practice nursing granted by the board of nursing in the state that you become licensed then, alright. Now, the whole purpose of this test, alright, the whole purpose of the NCLEX is to determine if you are a safe entry level nurse and you’re able to think critically. Now, the NCSBN, National Council of State Boards of Nursing, who administers the NCLEX, that’s their goal in administering this test, is to determine if you’ll be a safe entry level nurse and if you have the ability to think critically.
So at this moment, let’s go and let’s talk about the actual structure of the NCLEX, how it works, how computer adaptive testing works, and then we’ll come back to this lecture after we’ve done that. The NCLEX is administered via a computer adaptive testing method. Essentially, all this means is that the computer selects the next question based on how you did on the previous one. The purpose of this and the reason that the NCSBN does this, is that the NCLEX gauges your knowledge based on the predetermined level of passing, the passing standard. Rather than it gauges you compared to other test takers. Now, there’s a few algorithms you use to administer the test to deliver you the next question. So, let’s go ahead and dive in to these algorithms so you can understand really what’s being thrown at you and how the test questions are being selected for you. The first one we’re gonna talk about is called passing standard. This passing standard simply means that if you score above this level, you pass the test. If you score below this level, you don’t pass the test. Now, because of this, passing the NCLEX is completely independent of the number of questions you get or the length of time it takes you to take the test. And this passing standard is set by the NCSBN, they set the minimum standard that everybody must score on or score above to pass. You can’t do anything to change the standards, you can’t prepare to meet the standard. This standard is set by them and you must score above it in order to get that RN.
Now, the next one I wanna talk about and probably the most important, okay, is 95% confidence interval. 95% Confidence interval can sound really confusing, it really is pretty simple. Essentially, the NCLEX is going to end when it determines with 95% confidence that you’re above the passing standard. Now, like I said, this is what is going to end the NCLEX for most people. The test is either 95% confidence, you’re above the passing standard, or is 95% confident you’re below the passing standard? So, the test starts the same for everybody. Everybody has the same kind of 95% confidence interval. And the test begins to feed you questions, okay? With each successive question, this 95% confidence interval narrows and narrows and narrows until it’s certain it knows where you’re going to answer within 95% confidence the next question. So, think of it as kind of a graph. Okay, we have a graph here. And the straight line is the passing standard. One question is delivered to you, you score that question right, so, your passing standard, your 95% confidence interval begins to narrow a little bit above the passing standard. With each question, as you progress on, that 95% confidence interval begins to narrow, it begins to shrink, moving either further above or to passing or moving farther below to failing. So, because of this guys, and I want you to listen really closely to this. Because of this, the number of questions it takes you to pass the NCLEX matters very little. The amount of time it takes you to pass the NCLEX matters very little. What matters is that you eventually pass.
Now, another algorithm used on the NCLEX is the maximum test length algorithm. What this means simply is that you can have a maximum of 265 questions for the NCLEX RN or 205 questions for the NCLEX PN. If you get to that point, and haven’t reached the passing standard, your 95% confidence interval is not above that point, we’ll go back and analyze that and say, okay, you failed. If you get to 265 questions and it determines, yeah, okay, you’re above the passing standard, you can go on and you can pass the test.
The last rule I want you to be aware of is the Run-Out-of-Time rule. The Run-Out-of-Time rule is very simple. You’re allowed 6 hours to take the NCLEX, whether you’re RN or whether you’re PN. You get 6 hours. If you get to 6 hours and you’re 95% confidence interval isn’t where it needs to be, you fail the test. If you get to 6 hours, and your at 95% confidence interval is spot on, you’re good to go, you get your RN.
Alright, now, let’s go back to our lecture and let’s talk about what questions are gonna be given to you. Now, we understand the test, we understand what’s gonna be, how it’s gonna be administered to us, let’s talk about what we’re going to be asked. Okay, so now we understand the basics of computer adaptive testing, now, we understand kinda how that all works, how the NCLEX is actually structured, and it’s pretty awesome and that’s really what we’re very excited about when we developed SIMCLEX, was being able to incorporate these algorithms like no one else is doing to give you the most realistic testing environment. So, I really want you to spend some time in SIMCLEX, once you have some time to go through nursing practice questions, some of the courses, some of the other tools, I want you to get to SIMCLEX so you can kinda get that realistic feel of how the test is different. I promise you every time you take a SIMCLEX, it’s gonna be different. We don’t just throw 75 questions at you, we don’t just make you work up level to level until you get to the highest level of question. What we do is we actually deliver you a computer adaptive test. So, make sure you spend some time in SIMCLEX and get a feel for how it works.
So, let’s talk a little bit about question selection. Now, as we talked about before, and as we talked about, you know, the structure of the NCLEX, questions are selected based on the result of the previous question while your 95% confidence interval begins to narrow. Now, aside from that criteria, aside from everything we talked about, the test will also deliver you questions from specific nursing categories in a set distribution. This will make more sense as we get into it. Now, according to the 2016 test, one of the most recent test plan, these categories were divided out into Safe and Effective Care Environment and that was divided into 2 categories. Management of Care taking up 17-23% of all the questions you got on the NCLEX and Safety and Infection Control taking up 9-15% of all the questions you got. So, for example, if you got a 100 questions, 15 of those would be about safety and infection control, okay? Now, the other areas would be Health Promotion and Maintenance, that’s gonna be just 6-12%, the nurse’s Psychosocial Integrity, things like your mental health, your therapeutic communication, and things like that is gonna be 6-12% as well. Then, we have Physiological Integrity. This is where we really get into taking care of our patient’s disease process, taking care of our unique patient physiologically. That’s gonna be Basic Care and Comfort 6-12%. Pharmacological and Parenteral Therapies is 12-18%. You can see this is why we focus a lot in what we teach on medications and on how they work and how they function in the body. It’s gonna be just for the NCLEX alone, it’s gonna be 12-18% of your entire test. And Reduction of Risk Potential, that’s gonna take up 9-15%. Then we have Physiological Adaptation, that’s really what we’re doing like these MedSurg things. How do we help our patient adapt and grow with their disease process. Now, I wanna talk something a little bit different here too. What I wanna do is I wanna give guys, and this is all down in the text. But I wanna give you guys a little outline of some of the type of questions you’re gonna be asked about in each of these areas. So, for example, in Management of Care. Now, Management of Care, you can see it takes up up to 23% of your test. So, one quarter of your test is about management of care. So, it’s very important to the NCLEX that you understand Management of Care. That’s part o our safe and effective care environment. That’s things like advanced directives, advocacy, case management, client’s rights, referrals and informed consents, ethical practice. So, a lot of these things are in our fundamental courses, assessment, delegation, supervision, so, it’s very very important that you understand this portion of nursing. Now, this question might not directly be an advocacy question. It might involve a heart failure patient understanding the physiology of heart failure and how do you advocate for that patient’s heart failure. So, it’s gonna be still around safe care but you’re having to deal with the MedSurg issue too. Remember, that’s when we talked about Bloom’s Taxonomy. That’s when we talk about the analysis level. We’re not just gonna be like “What is advocacy?” You know, ‘cause that’s just way too easy. It’s gonna be here’s a patient, with this disease process, how you gonna advocate for this patient, what are some things that the nurse would do to advocate for that patient?
When we talk about safety and infection control, that one’s pretty obvious. We’re gonna be talking home safety, safe use of equipment, accident, injury prevention, ergonomic principles and emergency response plan, things like that. When we talk health promotion and maintenance, that’s gonna be things like aging process, high risk behaviors, things like smoking, exposure to the sun, working, you know, around asbestos, they used to love to ask about asbestos, lifestyle choices, self care, screening, things like that.
Now, psychosocial integrity, okay, that’s gonna be 6-12% of your test, that’s gonna be family dynamics, grief and loss, end of life care, behavioral interventions, coping mechanisms, crisis interventions, so, that’s really, you know, these pieces of therapeutic medication that we’ve been learning and that’s you know really gonna be what that’s all talking about, alright.
And then, when we get down to our physiological integrity, this is my favorite section, this is what I really love is physiological integrity. This is gonna deal with the basic care and comfort. This is gonna deal with the assistive devices, rest and sleep, personal hygiene, mobility and mobility non-pharmacological interventions. Not area that I really, it’s not my passion there, it’s not what I really love talking about. These last 2 areas are what I really enjoy talking about. And together, they make up about 30% of the test. That’s gonna be pharmacological and parenteral therapies. Things like adverse effects, contraindications, side effects, blood and blood products, central venous access devices, doses, calculations, expected outcomes of medications, med admin, TPN’s, pharmacological pain management. So, this is more really getting into pharmacology. Now, again, you might not be getting one with what kind of medication is Lisinopril? What you’re gonna get is gonna be talking about, you know, a patient comes in, African American comes in with angioedema, what are you gonna do? You know, you’re gonna ask about ACE inhibitors. Have they been taking ACE inhibitors and then what are you gonna do beyond that, okay. Then, we get into our reduction of risk potential. Reduction of Risk Potential is gonna be things like laboratory test, diagnostic test, therapeutic procedures. You know, this is really like how do we take care of a patient as they’re in the hospital and how do we move them through this process. Then, we get down to my favorite section, this is physiological adaptation. This is where we get into Anatomy and Physiology, alterations in body systems. So, we get to know our body systems, we’re gonna know what can happen. And that’s why in our MedSurg course, we’ve divided it out by body system. Because it’s really important you know what are the most important things that you need to know by body system and what are those linchpins by body system? Then we have fluid and electrolyte imbalances, hemodynamics, love that area, one of my favorite areas, hemodynamics and you can see that in the cardiac course, you’re gonna see it throughout MedSurg and stuff. Then, we have illness management, medical emergencies, pathophysiology, and unexpected.
Now I wanna get into some epic Q’s, some of the big questions that people ask about the NCLEX. Now, I’ve kinda consulted with the NCSBN on what some of those main questions people ask and then some of the things that people ask us and this will help you understand why we’ve structured SIMCLEX the way we have some of this epic Q’s. Because it’s really is built around to give you the most realistic experience possible. So, let’s address some of these things. One of the main questions people ask is “Can you skip questions on the NCLEX?” No, you cannot. Simple as that. You can’t skip a question. You have to answer every question. Now, when you get a test report or will you get a test report? There’s only one instance where you’ll gonna get a test report. And that’s if you failed the test. If you do not fail the test, you won’t get one of these. What they call this, they call this a performance report, and if you get one of these, you’ll only gonna get this if you fail, you’re gonna get a candidate performance report and it’s gonna take down all those different NCLEX areas that are tested on. And it’s gonna tell you how you performed, if you’re near passing, if you failed, if you passed at that area. Now, what I want you to do if you have already taken the NCLEX or if you do fail the NCLEX, is I want you to use that report to then refocus your studies. Now, again, in this module, we talk about what exactly you need to be studying for each area. So, if you failed Physiological Adaptation, you would need to go back in and look at those types of things, okay, and really study those types of things when it comes to your continued testing. Does the NCLEX bold key words, like most, priority, best, highest? Yes. On test questions, where it’s like, what are the most important thing? Which one of these is a priority for the nurse? The best intervention. Those types of words are going to be bolden. Now, one question we get all the time is will all medications be listed in generic or trade name? The NCLEX list medications by the generic name, okay, you have to learn these generic names and that’s gonna be consistent in Canada, in the U.S., whatever, they’re gonna be using generic names. At what cognitive level is the NCLEX written? Most questions on the NCLEX and if you’re doing really well on the NCLEX, most questions are gonna be written at the application or higher level. Again, go back to Bloom’s Taxonomy to see if you understand. Now, one thing people ask a lot is what types of alternate format questions are there gonna be? Yes, there’s gonna be alternate format questions, there’s multiple choice questions, there’s alternate format questions. Most of these alternate format questions are still gonna be kinda multiple choice type questions. You’re gonna have to select all that applied or you’re selecting more than one correct answer, you’re gonna have fill in the blank where it’s like here’s something and then here’s a few words, you need to fill in the blank there. There’s hotspot graphics where you can see a picture of like a chest and you have to select where you would listen for the apical pulse or where you’re gonna listen for or where you would, you know, feel for apical pulse or whatever. And they’re gonna give you these types of questions. We have to click on an area on the diagram to determine if you know where you would do something. Then, there’s ordered responses, these can be a little bit tough for people, it’s gonna say, you know, you’re about to start a Foley catheter, here’s 5 things you need to do, and then you have to drag and drop which ones you would do first and what order you would do them. The difficult thing that I don’t like about those is you miss one thing, one little piece of the order, you get the whole question wrong. Those can be really tough questions. Then, you have audio questions where you’re gonna listen to, you know, maybe a heart sound, a breathing sound, you might listen to a report and you’re gonna say it’s gonna ask you if you heard what you heard and see if you got it right. Then there’s graphic answer options where the answer options are actually pictures. So, I would say like which of these signs indicates isolation precautions where you would have to select the right one. Now, another question that people ask a lot is what does the test screen look like? So, I’m gonna show you basically exactly what the NCLEX test screen looks like. This is what you’re gonna see when you go in and take the NCLEX, it’s almost exactly like this. Blue bars. You’re gonna have a calculator up here where you can pop this out, brings a calculator out over here where you can type in your calculations. Then, you have your time button up here. If you click on the time, it will actually collapse it, so you don’t see that anymore. I did do that during the NCLEX, I collapsed it, so I wouldn’t see it. So, it didn’t distract me. Then, you can also collapse the answers here, I also did that as well, or the question, you know, it’s not gonna tell you out of how many, it’s gonna say Question 65, Question 95, Question 200. So, I collapsed that because I don’t wanna be distracted by my time and I didn’t wanna be distracted by the questions. What I did do is I make sure I gave myself enough time to be able to have equal amount of time on all 265 questions if I took a whole 6 hours. So, I tried to get myself that amount of time per question. But in general, I didn’t stress about the time, I didn’t stress about what question number I was on, really can’t stress about these things. The one moment I did stress about question number was when I answered question 75 and I hit submit, that’s when I was a little bit stressed because everyone knows your test could end at that point. And beyond that point, you’ll never know when it would put in. So I was a little bit stressed when I hit the button for 75. Then, what you’re gonna see here, so here’s what the question is, this is the item, item is gonna be up here and then your answer options are gonna be down here. Okay, then, what you’re gonna see here is you’re gonna have your next button, okay. You’ll just click Next after you answer. Your name is gonna be up here. And this is really what the NCLEX test screen is gonna look like. This is what you’re gonna see and we’ve mimic some of these things in SIMPLEX so you can see really what it looks like as you take an NCLEX test. Now, guys, I want you to take these things, I want you to battle all these information up and I want you to use this the way you study. But, you don’t have to worry about this a ton because this is what we’ve done in the academy. Okay, we structured our courses to match the test plan. We’ve added the tools you need to feel comfortable, and to learn and to gain an extra information you need. So, guys, now go dive in, get into these courses, figure out where you’re struggling, look at these different areas below in the text, you’re looking at these different areas and you need to focus your studying on, okay. And focus on those things that you’re weak and so you can become stronger and better in the test.