From the archive: this describes the NCLEX-RN as it ran in 2018. NCSBN introduced the Next Generation NCLEX in 2023, which changed the question types, length and timing. Check NCSBN for the current format.
So you’re preparing to take the NCLEX-RN. Fantastic. It is a milestone in your nursing career, and a significant investment, so you want to give yourself the best chance of passing.
The most important thing to know about the test is that its questions are designed to gauge your ability to make sound decisions in complex scenarios. You develop a kind of nursing calculus, grounded in an experience-based feel for how a hospital runs. The multiple-choice questions are not fact-based. They test your ability to weigh options in an informed, effective way in clinical situations where no single choice is necessarily the only viable one.
You will not be asked, for example, the ratio of salt to water in a saline drip, or how many milliliters of morphine a 190 lb man should get for post-operative pain. Instead, you will see scenarios like this one:
A psychiatric client with a history of violence has been court-ordered to take a personality evaluation after torturing a neighbor’s cat. To evaluate the client for signs of potential violence, which clues should a nurse consider most relevant?
- Rigid posture, glaring and restlessness
- Physical withdrawal and depression
- Noncompliance and silence
- Talk of previous violent acts and hypervigilance
As you can see, some answers are better than others, but the situation calls for judgment.
The 2018 format
In 2018 the exam was computer-adaptive: you answered a minimum of 75 questions and up to 265 to demonstrate competence, including 15 unscored pretest questions. You had six hours to complete it, with an optional break after the second hour.
According to the Maryland Board of Nursing at the time, the first-time pass rate was roughly 77.6%.
There are many resources to help you prepare, but one of the best strategies is to answer NCLEX-style practice questions every day. Skyscape’s NCLEX apps let you study or quiz by content area, and include the Next Generation NCLEX question format.