12 Must Have NCLEX® Study Tools (4 are FREE) | NURSING.com

Many companies provide NCLEX review materials, all of which you can purchase online.  There are quite a few options, from just utilizing one book, to a self-guided online review, to test-taking strategies, to an in-person review.  What to buy really depends on your specific educational needs.

Consider:

• How do I learn best? Audio, video, printed, in-person
• Do I want something I can utilize on mobile?
• What can I afford?
• Do I need test taking strategies in addition to content review?
• Do I want access to practice questions? (Spoiler alert: YES)
• Do I want to take a simulation NCLEX?

There are many companies out there who provide review material.  Hurts, ATI, Kaplan, NRSNG Academy, the NCLEX Mastery App, and the NCSBN all provide different NCLEX review options with varying levels of support and guidance.  Check out their specific websites or go to NURSING.com/Academy for a comparison chart.

Buckle up. This can be a little confusing.  First of all, the majority of this paperwork is done online.

First, you must register with the state board of nursing located in the state you woud like to practice in.  This specific state board of nursing will determine if you are eligible to take the exam in the first place. They typically do the background check and require you to submit fingerprints. Being a nurse is not just passing the NCLEX, you must also be deemed appropriate for licensure.  (There are people who can pass the NCLEX, but it wouldn’t be appropriate to grant them a license… say they were convicted of some major offense which would deem them ineligible. Typically those kinds of things would prevent someone from entering nursing school in the first place, but it’s important to have these application safeguards in place.)

Let’s go through an example. If I want to work as a registered nurse in Texas, I would go to the Texas Board of Nursing website and look for an option to apply for the NCLEX.  I then complete and this application form, pay the fees, and submit the required paperwork and documentation.

Next, once I have applied in Texas, I would then register with Pearson Vue (no matter which state I want to work in).  Pearson Vue is essentially the company who administers the NCLEX. Here is where I would go to create an account with Pearson Vue. I would register with them, and again pay fees. (Blerg.)

Once I have completed both of these steps (applying with your State Board of Nursing and registering with Pearson Vue), I must wait. I must wait until I receive an email with my Authorization to Test (also known as an ATT).

This document essentially communicates that you are eligible to test for the NCLEX from the perspective of your state board of nursing. You MUST have the ATT to schedule a test date.  There are no exceptions. An ATT is typically only good for 90 days. If you don’t want to test for 6 months (which we do not recommend, test as soon as you’re ready), don’t go through this process now.  Wait until you’re closer to when you would like to test.

Finally, after receiving your ATT you may schedule your NCLEX test day.  You can do this online or via phone (we recommend scheduling online). You basically sign into your previously created Pearson Vue account, and schedule a date.  They will provide a list of dates and locations.  It is essential you schedule your test date as soon as possible after you receive your ATT.  Remember, the ATT’s expire, so if you wait to schedule until near your expiration date, they cannot guarantee that you can test before it expires.

Checklist:

1. Apply with your state board of nursing
2. Register with Pearson Vue
3. Wait for your ATT
4. Receive ATT
5. Schedule your test date with Pearson Vue
6. Test!

 

You get to choose where you take the NCLEX!  Whenever you’ve received your ATT and go online (or call) at Pearson Vue, they will give you options of locations near where you live as well as testing times. Where you go is completely up to you and doesn’t even have to be in the same state you will practice in. Consider how long it will take to get to the testing center when selecting a test time.  So if it will take you two hours to drive to this location, consider that when selecting an 8:00 am test time.  There are many test centers all over the country. Click here to enter your zip code to see what’s near you. You may do this at any time.

 

 

While this exam is taken on a computer, they do not instantly provide results.  This is very intentional, as they want to be extremely cautious and ensure everyone who the computer says “passed” actually did pass. They do not want to give someone a nursing license who didn’t actually pass, but a computer error said they did.  Therefore, every single exam is scored twice.

In some states, can find out if you passed in as little as 48 hours. This is called the “Quick Results Service”. Click here for a list of participating states. You go to the Pearson Vue website, log into your account, select “Quick Results,” pay a fee (ugh) and they will give you unofficial results. However, this does not authorize you to practice as a nurse.

Only your state board of nursing can release official results, and the processes for notifying people may different.  However, most states mail official results within six weeks.

 

 

The NCSBN (National Council of State Boards of Nursing) comes up with the content for the NCLEX and also creates the passing standard. Every three years, the NCSBN basically analyzes how entry-level nurses practice. The questions on the exam are written by practicing nurses, which are then reviewed by a second panel of nurses, based on what an entry-level nurse should know to safely practice. These questions are then pre-tested before being allowed to be officially part of the examination. Source.

 

 

The National Council of State Boards of Nursing (NCSBN) writes the NCLEX.  Currently practicing nurses write the questions based off of the previously established standard (that is routinely reevaluated), which are then reviewed by a second panel of nurses. After this, the questions are then pre-tested before being allowed to be officially scored in the NCLEX.

 

There are different kinds of NCLEX questions. You have both the standard 4-option multiple choice questions with one answer, and alternate format questions.

A standard multiple choice question looks like this:

So, what are you doing right now?

1. Reading the NCLEX FAQ’s
2. Pretending I’m Carla from Scrubs
3. Making cookies
4. Working out

Alternate format questions are any of the following:

1. Select all that apply: at least two answers are correct
2. Ordered response: you put the answers in the correct order
3. Charts: you are given a chart, or exhibit, and have to analyze that to provide the appropriate answer
4. Audio: you must listen to an audio file and select the correct answer based off of what you heard
5. Fill in the blank: a word will be missing and you have to type in the answer
6. Hot-spot: you’ve given a picture and have to click on the area that is the correct answer (where you would apply pressure to assess McBurney’s point, for example)
7. Graphics: your given pictures (like of ECG strips) as answer options and need to select the correct one.

You may get any number of multiple choice and alternate format questions.  You may get more select all that apply, only 1-2 charts, 3 audio, and 2 hot spots.  There isn’t a set order of questions or question types.

 

The NCLEX is a pass/fail exam – but it’s not quite that simple or easy to explain. A passing standard is decided upon by the NCSBN, which is explained in detail here. Basically, there’s isn’t a passing score like your other exams. You can’t just get a “80%” to pass because it is much more complicated than that.

The NCLEX is a computer adaptive test, or CAT for short. (Meow…)  Essentially, everyone’s test is different because it is constantly adapting questions based off of the answer you provided in the previous question, all in an effort to ensure you are answering at least 50% correct at the level of their passing standard.

You are given a question to start with that is essentially medium difficulty. If you get it wrong, it gives you an easier question. If you get it right, it gives you a harder one.  It keeps adapting to your answers (giving you easier or harder questions), until you’ve answered enough correctly to show them you’re above their passing standard.  That’s why some people get the minimum questions of 75 (60 scored, 15 that are being pre-tested and not actually scored), and some get the maximum of 265.

 

An acceptable form of identification must include your name exactly as it appears on your authorization to test (ATT).  It also must be current, government-issued, and have your photograph and signature on it. Some examples of acceptable forms of ID include your driver’s license, state ID, or passport. The only acceptable name change documents are marriage licenses and divorce decrees.

This is serious. You will be turned away if you don’t have appropriate identification. And you’ll have to pay again.  

They will take your picture, signature, and palm vein scan. There are no exception, these must be obtained.

You do not need your authorization to test (ATT).

You can bring your keys, phone, and so forth, but if you do, you will be required to store it in a locked container provided by the testing center, who will hold onto it until you’re done. They will make you take off any hats, coats, scarves, gloves, etc. (Religious head coverings are permitted.)

While you can take breaks, you cannot access those of your personal items during. Also, you can bring family, friends, but cannot talk to them until you are done and they must wait outside the testing area.

Basically, bring your acceptable ID (and the name on it must match your ATT exactly) and be ready to provide a signature, have a picture taken, and provide a palm vein scan.

 

If you choose to find out your via the Quick Results Service and your state provides this service, you can get unofficial results in as little as 48 hours.  You will get your official results from your state board of nursing, typically in approximately six weeks or less.

 

 

The NCLEX shuts off because it has decided that you have either met the passing standard and passed, or not and failed.  You will receive a minimum of 75 questions, therefore if you have demonstrated in those 75 questions (well, 60 questions with 15 being pre-test questions and not actually scored) that you have exceeded the passing standard, it shuts off and you’ve passed.  It keeps evaluating whether or not you’ve met their standard with each and every question, and once it makes a decision, it shuts off. There is a maximum of 265 questions and a 6 hour time limit.  Outside of the minimum and maximum numbers, there is no set number of test questions like there were for exams during nursing school.

 

 

Each examination is scored twice, and the results are given to your state board of nursing.  It is essential that they ensure that make sure the results are accurate and there are no errors.  It takes approximately 6 weeks to get your official results, but you can use the Quick Results Service in as little as 48 hours to get unofficial results if your state participates in this service.
However, the NCSBN may cancel or withhold results if they think something not cool has happened. A few reasons they give here include misconduct, violation of the rules, a testing irregularity, falsifying identification, or irregular activities.

 

 

The amount of time needed to study depends on the individual and their needs.  Taking a pretest after graduation to identify areas in which you need to focus is helpful.  In addition to identifying these areas, it’s also essential to know understand the way the questions are structured.  Start taking NCLEX practice questions and see how you’re doing, then gauge your efforts accordingly.  Taking test prep questions daily is very helpful until test day, with a day off here and there for a mental break.

 

 

You cannot take the NCLEX more than 8 times in one year per the NCSBN.  You must wait 45 days in between attempts. However, you should also look at your respective state board of nursing policy on retakes, as their standards may be different than the NCSBN.

 

 

Ok so answering this question will take some explaining, so bear with me.  You can take your NCLEX where ever you want.  What matters is where you want to practice.

I personally studied in Iowa, tested in Indiana, and practiced in Illinois.  

So, the NCLEX is the NCLEX. It’s written by the NCSBN and administered by Pearson Vue. That setup doesn’t change, no matter what state you’re in.  You take the test at a Pearson Vue testing center, and they send your results to whichever board of nursing you tell them to.  What does differ between individuals is which board of nursing you apply for your licensure. If you want to work in a state, you must apply to their board of nursing to work there.

If you have not taken the NCLEX yet, you would apply for “licensure by examination”.

If you have taken and passed the NCLEX already and been licensed by a state board of nursing but want to practice in a different state, you would apply for “licensure by endorsement”.  
To go back to my personal example, I graduated in Iowa.  I applied for my NCLEX like everyone does, no matter which state. I applied to the Illinois State Board of Nursing under “licensure by examination” and Pearson Vue simultaneously. Once I received my authorization to test (my ATT), I then selected my testing location on the Pearson Vue website. I lived near the Indiana border so the most convenient location was there.  I tested there, but was licensed by Illinois and practiced in Illinois.  

 

There are quite a few labs to know to be successful with the NCLEX. Please note that just because something is listed below doesn’t mean you will definitely see it on the exam.

Electrolytes: potassium, sodium, calcium, chloride, magnesium, phosphorus

Most common labs: RBC, HGB, HCT, PLT, WBC, PT, INR/PTT, Albumin, Creatinine, BUN, Glucose, HBGA1C, BNP, UA, Troponin I, Cholesterol, Ammonia, Total Bilirubin, Lactic Acid, ABG’s.

 

Please keep in mind that medications change… some get discontinued, and new ones are created. This list was compiled in 2016.  Also, it is impossible to predict the exact medications you will see on the NCLEX.  This is a list of the most commonly tested.  What is helpful to understanding these medications is also understanding their classification and mechanism of action. We created an entire course that discusses each of these meds in-depth, as well as classes of medications, skills videos, cheatsheets and downloads.  You can check it outhere, and it also comes in ourNRSNG Academy, along with ten other courses.

 

Here is the list of the most commonly tested meds, in alphabetical order by generic name*:

Acetaminophen, albuterol, alteplase, amitriptyline, amoxicillin, atenolol, atropine, bismuth subsalicylate, captopril, carbamazepine, carbidopa-levodopa, cefaclor, cefdinir, celecoxib, cephalexin, chlorpromazine, cimetidine, ciprofloxacin, clindamycin, codeine, cortisone, cyclosporine, clopidogrel, dexamethasone, diazepam, digoxin, diphenhydramine, diphenoxylate-atropine, divalproex, dobutamine, dopamine, enalapril, enoxaparin, epinephrine, epoetin, erythromycin, escitalopram, ferrous sulfate, fluoxetine, fluticasone, furosemide, gabapentin, gentamicin, glipizide, glucagon, guaifenesin, haloperidol, heparin, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, ibuprofen, indomethacin, insulin (novolog, novolin, humulin, lantus… basically all of the different kinds of insulin), iodine, isoniazid, ketorolac, lactulose, lamotrigine, levetiracetam, levofloxacin, levothyroxine, lisinopril, lithium, loperamide, lorazepam, losartan, magnesium sulfate, mannitol, meperidine, metformin, methadone, methylergonovine, methylphenidate, metoclopramide, methylprednisolone, metoprolol, metronidazole, midazolam, montelukast, morphine, nalbuphine, naproxen, nifedipine, nitroprusside, norepinephrine, olanzapine, omeprazole, ondansetron, oxycodone, oxytocin, pancrelipase, pantoprazole, paroxetine, phenazopyridine, phenytoin, procainamide, promethazine, propofol, propranolol, propylthiouracil, quetiapine, ranitidine, rifampin, rosuvastatin, salmeterol, sertraline, spironolactone, streptokinase, sublimaze, sucralfate, terbutaline, tetracycline, theophylline, trimethoprim-sulfamethoxazole, vancomycin, vasopressin, verapamil, warfarin
*The NCLEX will most likely provide the generic name rather than the trade name

 

 

Advancement and consistencies

• Advancing a diet: ice chips/sips of water, clear liquids, full liquids, soft/bland, regular (or whatever diet is appropriate for the patient)
• Liquid consistencies: honey-thick, nectar-thick, thin (regular consistency)
• Food consistencies: pureed, mechanical-soft, soft, regular

When you are concerned that a patient is not consuming enough to maintain appropriate nutrition

• Consult dietitian (many nurses are able to do this under a screening protocol, while some many need a physician order… this depends on your particular facility’s policies and procedures)
• Calorie counts
• Consider nutritional supplements
• Enteral or parenteral feedings may be necessary

Parenteral versus Enteral feedings

• Parenteral: intravenously, called Total Parenteral Nutrition or TPN
• Enteral: given down a feeding tube (nasogastric, Dobhoff, PEG), also called tube feedings (TF)
• Oral food and hydration is always preferred, the next step would be enteral nutrition, and finally parenteral nutrition. It is always best for food to be administered and absorbed in the GI tract rather than intravenously, which is why they look to discontinue/wean TPN as soon as it is medically appropriate

Diets to know

• Renal diets: quite restrictive…(protein, fluid, sodium potassium, phosphorus), but may be high in calorie
• Alzheimer’s, bipolar (typically manic-state), or other mental-health diagnosis in which patients may go longer periods of time without remembering to eat: promote finger foods
• Celiac disease / gluten-free: cannot have barley, rye, oats, wheat.  May not even be able to consume foods cooked on the same surfaces as these
• Cardiac diets: fluid, salt, certain fat restrictions
  • Grapefruit juice is also contraindicated in many cardiac medications
• Patients on Coumadin: restrict vitamin K
• Gastric irritation (diarrhea, colitis, gastritis): low fiber, increase fluids, ensure appropriate electrolytes are consumed
• Gallbladder issues: restrict fat
• Pernicious anemia: increase foods with vitamin B12 (fish, shellfish, liver, beef)
• Diabetic: conscientious of carbs and also may need to actually count the carbohydrates consumed to administer the appropriate amount of insulin

Consider pathologically what’s going on with the patient and then what would be best to ensure they are consuming what they need to maintain homeostasis.  For example, if you have someone who is nauseated and vomiting a lot, they most likely are going to have some electrolyte imbalances and dehydration… if someone has COPD and tires easily, we probably should provide higher-calorie foods in smaller but more frequent portion sizes so they don’t get too tired… if someone is constipated, we should look at foods with more fiber and increasing fluids.

 

 

The NCLEX Authorization to Test or ATT is distributed by the state board of nursing to which you applied.  To be able to take the NCLEX, you have to apply to your state’s board of nursing to see if you’re eligible. They do a background check, review your records, and decide if they will let you sit to take the NCLEX in the first place.  (Concurrently, you’ll also register with Pearson Vue, the people who administer the test.)

Once your respective state board of nursing says, “Yea! It’s cool with us if you want to take your nursing boards!” they send you a form that basically communicates that information to the company who administers the test (Pearson Vue).  With your ATT, you’re able to schedule your test date with Pearson Vue.  You must have this to schedule a test date, or else Pearson Vue will not allow you to schedule.

ATT’s expire. So don’t get your ATT until you know you’ll want to schedule a test date, otherwise you may have to go through the entire process again.
Also, if you have anything on your records (a DUI, misdemeanor, felony, or anything), know that it may take you longer to receive yours than your classmates. It doesn’t necessarily mean you won’t get one. It just means they need more time to thoroughly review your records before authorizing you to take your NCLEX

 

 

According to the NCSBN, 84.57% of US educated individuals passed the NCLEX on the first try in 2016 (Source). However, this is the big-picture number. If you’re curious about your specific school’s pass rates, which is very important to know as you’re deciding which school to go to in the first place, there is a very easy way to find out!

Go to your state board of nursing website and look for NCLEX pass rates.  They should provide list of all nursing schools in that state and their pass rates.  

Let’s go through an example….

Let’s say I was thinking about going to a few different nursing schools in Iowa (University of Iowa, Mount Mercy, and Iowa Wesleyan) and I wanted to see their pass rates before I made my decision.  I would go to the Iowa Board of Nursing website and then click on Nursing Education Programs, and then Nursing Education Program Statistics, and then selected NCLEX Results By Program.  Then I was given a PDF of first-time pass rates for the NCLEX in the state of Iowa from 2012-2015.

Here is what I found about the three programs I mentioned above for 2015:

• University of Iowa – 96% (out of 79 graduates)
• Iowa Wesleyan – 100% (out of 16 graduates) – spoiler alert: I was one of them!
• St. Ambrose – 76% (out of 51 graduates)

Ideally, you want to go to a school that will appropriately prepare you not only to pass this exam, but also to be a successful bedside nurse. You want to look at trends as well, because while Iowa Wesleyan had a 100% pass rate, their graduating class was a fraction of the size of the other two institutions.  If 1-3 people had not passed, that would have significantly altered the percentage.  
If you’re ever curious about the nation-wide NCLEX pass rates, just check out the National Council of State Boards of Nursing website (NCSBN), click on NCLEX, then Exam Statistics for the most up to date information.

 

The eligibility requirements to sit for the NCLEX vary from state to state and are dictated by that respective state’s board of nursing. However, most (if not all) states require prospective nurses looking to take the NCLEX submit transcripts which reflect that the candidate has successfully graduated from an approved nursing program. Some states will allow you to submit fees, fingerprinting and a background check before graduating to get the ball rolling, and then once you graduate you just send over your transcripts.  To find out definitively, take a look at your state board of nursing’s website.

 

 

While there is the possibility of a computer glitch, that is very very very unlikely.  In most cases (and none of the nurses on staff have ever heard of it being wrong), the Quick Results is correct.  Because accuracy is essential, each exam is scored twice. Your Quick Results information is the computer scoring the test before it is double checked.  After it is double checked, your state board of nursing is notified of your results.  They will mail the official ones to you within approximately 6 weeks. Only after you receive official passing results can you begin practicing as a registered nurse

 

 

The NCLEX categories are as follows:

• Physiological adaptation – 10%
• Coordinated care – 21%
• Safety and infection control – 13%
• Health promotion and maintenance – 9%
• Psychosocial integrity – 12%
• Basic care and comfort – 10%
• Pharmacological therapies – 13%
• Reduction of risk potentials – 12