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Nurses are highly respected and valued members of our society, and nursing has been named one of the most trusted professions. Nurses advocate and care for those who are in vulnerable positions. We wouldn’t want just anyone taking care of our loved ones, would we? It’s important for the nursing profession to have high standards for entry in order to protect the public. Potential nurses must be able to demonstrate that they are competent, and able to practice safely and compassionately. For these reasons, the NCLEX must be challenging—not impossible, but difficult.

Nursing students spend thousands of hours studying, going to classes, preparing for skills tests, and attending clinicals in order to prepare for graduation and taking the nursing licensure exam, the NCLEX. After all this preparation and studying, most students are still nervous about taking the NCLEX. Just how hard is this exam?

NCLEX Pass Rates

According to the National Council of State Boards of Nursing, in 2017, the first-attempt NCLEX pass rate for U.S.-educated nursing students was 87%. The second-attempt pass rate for domestically-educated students taking the test was 45.56%. These results demonstrate that it is a pretty difficult test. The questions are designed to test your critical thinking, knowledge of the nursing process, and assessment skills.

How Does the NCLEX Work?

The NCLEX is unique in that the computer software adjusts the difficulty level of the questions to measure your knowledge and competence. This method is called Computer Adaptive Testing (CAT). The computer assigns questions with increasing difficulty levels until an incorrect answer is given. Then, the computer will assign a less difficult question, and begin increasing the difficulty with each question again to determine exactly where your competence level falls.

Once the computer has determined that your knowledge level is satisfactory, the test shuts off. You may be given between a minimum of 75 and a maximum of 265 questions. Receiving the minimum of 75 questions does not necessarily mean that a passing score has been reached, and likewise, getting 265 questions does not imply a failing score. CAT keeps assigning questions until it has determined that your competency level meets certain standards.

What Causes a Failing NCLEX Score?

A failing score results from one of several situations. Either the test taker doesn’t answer the minimum number of questions (75) within the allowed time frame of six hours, a satisfactory competency level has not been met after taking the maximum number of questions (265), or the computer determines early on that the taker has scored poorly enough to be unable to recover their score even if the maximum number of questions were to be assigned. In this last scenario, the tester may still fail after receiving a low number of questions.

What Kinds of Questions Are There?

One of the best ways to increase your chances of passing the NCLEX is to get REALLY familiar with the different types of questions. The NCLEX includes fill-in-the-blanks for calculation questions, multiple choice, order response, and select-all-that-apply questions, or SATA questions. There are a handful of great free tools that can help you prepare and get accustomed to these style of questions. If you have weeks or months to prepare; you can get a head start with an NCLEX question of the day.

Order response and SATA questions tend to be the ones that give test takers the most difficulty. Order response questions give you a list of actions, and a scenario. You must put the actions in the order in which they should be performed in this particular scenario. SATA questions provide a statement or scenario, and then a list of potential answers. The test taker must decide whether or not each answer applies to the scenario. Order response and SATA questions are difficult because there are multiple opportunities to select the wrong answer or place actions in the wrong order in each question, which both lead to failing the question.

Tips and Tricks for the Most Difficult NCLEX Questions

If you struggle with unit conversions, make sure that you become very comfortable with them before taking the NCLEX. There are fill-in-the-blanks questions for drug dosage calculations, meaning you can’t rely on multiple choice options to help you out.

In order to perform well on order response questions, it’s necessary to have a good grasp on prioritization and the nursing process. Remember, ADPIE is your friend – Assess, Diagnose, Plan, Implement, and Evaluate. Remembering ABCDE prioritization (Airway, Breathing, Circulation, Disability, Exposure) will also help you with these questions.

When it comes to SATA questions, remain calm, and try to view these questions as extended true-or-false questions. When considering each answer option, re-read the question and determine whether or not that particular answer pertains to the question. While this strategy certainly doesn’t make the questions any easier, it does help reduce some anxiety. Who doesn’t like true-or-false questions? Let’s just be glad there aren’t any essay questions on the NCLEX!

Preparing to take the NCLEX is enough to make just about anyone nervous. It’s a difficult exam, and a major stepping stone in your career as a registered nurse. Remember that most people pass the NCLEX on the first try. However, preparation and confidence are key to passing.

 

Holly Rinehart, RN

Holly Rinehart, RN, is an experienced Registered Nurse with a demonstrated history of working in the hospital & health care industry.

Latest posts by Holly Rinehart, RN (see all)

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