National Council Licensure Examination, developed and administered by the National Council of State Boards of Nursing, Inc., with services provided by Chauncey Group International (formerly, Educational Testing Service [ETS]) and Prometric Testing Centers (formerly, Sylvan Learning Systems).
Tests for minimum nursing competence according to a national standard.
Pass/fail result; must pass to be issued license from state board of registered nursing.
National exam. Application procedure and li¬censing requirements are determined by each state board and may differ from state to state.

Multiple choice questions, each with four options.
One question at a time appears on screen, with question stem on the left and options on the right, or with background information on the left and question stem with options on the right.
Each question stands alone (no "scenarios" with several spin-off questions); no question will relate to information given in previous questions.

Answering

As candidate chooses the answer to each question, he or she will be asked to confirm that answer, or can change that answer before confirming.
Must answer every question (no penalty for guessing; will simply count as a correct or incorrect answer and adjust difficulty of next question accordingly).
Cannot go back to previous questions either to review or change answers (because subsequent questions are administered based on previous answers).

Number of questions

75-265, including about 15 "tryout" questions that are not scored (these are questions being field tested for use on future exams).
Depends on number needed to determine whether candidate is definitely above or definitely below minimum competence level.
Taking only the minimum can mean either pass or fail; it indicates that it took fewer questions to determine whether this candidate is above or below minimum competence, but does not indicate which!

Timing

No time limit for each question.
Maximum time for test is 5 hours.
A 10-minute break is mandatory after 2 hours; an optional 10-minute break may be taken after another 1 Vi hours.

The test will stop when any one of the following occurs:

A "pass" or "fail" determination can be made.
The maximum number of questions has been taken.
The test has lasted for 5 hours.

The Computer

Computer experience will not be necessary.
Estimated ability is recalculated after each question until it is precise enough to determine whether the candidate is above or below mini mum competence level, in all areas of the test plan. The test will stop as soon as this is determined.
Example: The first question is of a fairly easy level. The candidate answers correctly, so the computer estimates that the candidate's ability level is above the level of this question and selects a harder question; or if the candidate answers incorrectly, it selects an easier question, to pinpoint where the candidate's ability level lies, in each area of the test plan.

CAT: How it works

Stands for "computer adaptive testing
"Adaptive" because the computer estimates the candidate's ability after each question; the next question is chosen based on the candidate's estimated ability so far. The test is therefore "adapted" to each candidate; everyone takes a different, "customized" test.
Candidate receives a brief orientation in the use of the mouse and on-screen calculator with sample questions before beginning the exam.

1. How many questions will there be?

You will take anywhere from 75 to 265 multiple choice questions.

2. Where do the questions come from?

The state boards of nursing nominate item writers, who must meet various criteria.

3. Will there be questions involving conditions with which I may not have had experience in my nursing program?

Most of the questions are about patients with conditions familiar to you and are representative of common health problems on a national basis. Some questions may relate to nursing problems with which you may not have had prior experience; their purpose is to test your ability to apply knowledge of specific principles from the physical, biological, and social sciences to new situations.

4. Can a question have more than one answer?

No. Only one of the four options is the best answer. You will not be able to choose more than one option as your answer.

5. Will I get partial credit for selecting the next-to-the-best answer?

No. Your answer will be treated only as correct or incorrect.

6. If everyone takes a different test, how can it be fair?

Each candidate is tested according to the same test plan, and the same passing standard. It may simply require more items to reach a stable pass/fail determination for one candidate, while another may require fewer questions to demonstrate competence level.

7. Do diploma, associate, and baccalaureate graduates all take the same test?
What about graduates from schools outside the United States?

All candidates are held to the same test plan and passing standard, and take the "same test." (Of course, due to the nature of CAT, each will receive an "individualized" test, without regard to degree, or to state or country of education.)

8. Does the exam differ by state?

The exam is a national exam; all candidates are held to the same test plan and passing standard, and take questions from the same pool. (Again, through CAT, each candidate receives an "individualized" test, but without regard to state.)

9. How is the exam different from the old "paper-and-pencil" test?

The purpose, test plan, and nursing knowledge and skills tested did not change significantly with the advent of CAT (there were minor adjustments to the test plan in October 1995, unrelated to the change to computer testing). The main differences lie in the efficiency of the computerized testing (maximum of 5 hours and 265 questions, compared to the old 2-day test with up to 372 questions) and the adaptive nature, which precludes skipping questions and changing answers.

1. Can I skip questions?

No. You must answer each question in order to move on to the next. You also will not be able to return to previous questions to try them again or change the answer (because subsequent questions are administered based on previous answers).

2. What if I just don't know the answer?

You will need to answer the question in order to move on to the next question.

3. When will I know my results? Will the computer tell me?

You will not learn your pass/fail status at the testing center; the results will be communicated directly to your state board of nursing, who will mail the results to you. The time frame may differ from state to state, but most candidates should receive their results within 2 to 4 weeks after taking the exam. NOTE: Taking only the minimum number of questions, or taking the maximum, is not an indication of whether you have passed or failed. It merely indicates that a lesser, or greater, number of items was required to reach a determination.

4. What percentage must I answer correctly to pass?

Because of the nature of CAT, a percentage rate is not used to determine passing or failure. The test determines whether you are above or below standard competence by determining not the number of questions you answer correctly, but rather the difficulty level you can consistently answer correctly. The process of administering harder or easier questions, continues until you reach the level where you answer approximately 50% of the complex questions correctly. NOTE: When practicing with questions of mixed difficulty, such as those in this review, you may wish to use 80% correct as a "benchmark" goal for yourself.

5. If I do not pass, can I retest only those areas of the test plan in which I tested poorly?

No. The whole exam is on a pass/fail basis.

6. Can I repeat the exam before I get my results?

No.

7. How many times can the exam be repeated, and when?

The National Council allows you to repeat the exam a maximum of four times per year, but not more than once in any 90-day period; however, each state board may set its own, more restrictive time limits and retake requirements.

8. Who grants the nursing license?

The license is granted by the state board of nursing to which you applied and for which you took the exam.

A. Test plan

Client needs are the bases, or "dimensions," for the test plan.
Health needs of clients: The test plan primarily emphasizes meeting the clients' physical needs in actual or potentially life-threatening, chronic, or recurring physiological conditions and the needs of clients who are at risk for complications or untoward effects of treatment. Subcategories include (1) basic care and comfort, (2) pharmacological and parenteral therapies, (3) reduction of risk potential, and (4) physiological adaptation.
The second two highest categories of emphasis are safe, effective care environment which focus on (1) management of care and (2) safety and infection control; and health promotion and maintenance, covering (1) growth and development throughout the life span, and (2) prevention and early detection of disease. Finally, 10-22% of the test plan concerns psychosocial coping and adaptation in stress-and crisis-related situations throughout the life cycle.
Nursing process (nursing behaviors): The exam integrates steps of the nursing process, as applied to client situations from all stages in the life cycle and to common health problems in all the major health areas and based on current morbidity studies.
Levels of cognitive ability: Most items are at the application and analysis level (application of principles, ideas, theories; and analysis of data to set priorities and see relationships), but include knowledge and comprehension.
Categories of nursing knowledge and other concepts that are commonly tested:
1. Caring ways by which nursing can assist individuals to maintain health and cope with health problems.
2. Communication
3. Effect of age, sex, culture, ethnicity, and religion on health needs (sociocultural components) are integrated into all units.
4. Documentation; legal and ethical aspects of nursing, accountability.
5. Self-care.
6. Teaching-learning (see health teaching sections [after the conditions'] that are part of Nursing Care Plan/implementation).
7. Nursing fundamentals.
8. Nutrition and diet therapy.
9. Pharmacology.
10. Communicable diseases.
11. Natural and behavioral sciences.
12. Normal growth and development.
13. Basic human needs.
14. Individual coping mechanisms.
15. Actual or potential health problems.
16. Life cycle.
17. Patient environment (protection from harm against airborne irritants, cold, and heat; identification of environmental discomforts such as noise, odors, dust, and poor ventilation; elimination of potential safety hazards; maintenance of environmental order; and cleanliness).

B. Development

The Examination Committee of the National Council prepares the test plan, which is approved by the delegates representing the state boards of nursing. It is designed to reflect the knowledge and skills needed for minimum competence by a newly licensed nurse to be a safe and effective practitioner in entry-level nursing, as determined by studies of nursing practice (performed every 3 years to reflect current nursing practice).
State boards take turns nominating item writers (faculty, clinical nurse specialists, or beginning practitioners); the Board of Directors of the National Council then selects from this group those who meet the criteria for item writing based on expertise in a particular area of nursing, type of nursing program, credentials, regional balance, etc. The item writers write questions based on common clinical situations and according to the test plan. Then the questions are researched and reviewed by a panel of experts (nominated by the state boards), by those state boards that choose to review, and by the National Council's Examination Committee.
Finally, the questions are field tested to eliminate questions that may be ambiguous, irrelevant, or not equally applicable to all regions of the United States. (Each candidate taking NCLEX will take 15 of these "tryout" questions, mixed in with the regular questions; they will not count toward that candidate's performance.) The data gained through field testing are also used to analyze and determine the difficulty level of a question.

C. Passing standard

The passing standard is criterion referenced; this means that there is no fixed percentage of candidates that pass or fail. Passing depends solely on performance in relation to the level of minimum competence. The passing standard is reviewed every 3 years.




	What NCLEX is?
	National Council Licensure Examination, developed and administered by the National Council of State Boards of Nursing, Inc., with services provided by Chauncey Group International (formerly, Educational Testing Service [ETS]) and Prometric Testing Centers (formerly, Sylvan Learning Systems). Tests for minimum nursing competence according to a national standard. Pass/fail result; must pass to be issued license from state board of registered nursing. National exam. Application procedure and li¬censing requirements are determined by each state board and may differ from state to state.
	Format
	Multiple choice questions, each with four options. One question at a time appears on screen, with question stem on the left and options on the right, or with background information on the left and question stem with options on the right. Each question stands alone (no "scenarios" with several spin-off questions); no question will relate to information given in previous questions.
	Answering
	As candidate chooses the answer to each question, he or she will be asked to confirm that answer, or can change that answer before confirming. Must answer every question (no penalty for guessing; will simply count as a correct or incorrect answer and adjust difficulty of next question accordingly). Cannot go back to previous questions either to review or change answers (because subsequent questions are administered based on previous answers).
	Number of questions
	75-265, including about 15 "tryout" questions that are not scored (these are questions being field tested for use on future exams). Depends on number needed to determine whether candidate is definitely above or definitely below minimum competence level. Taking only the minimum can mean either pass or fail; it indicates that it took fewer questions to determine whether this candidate is above or below minimum competence, but does not indicate which!
	Timing
	No time limit for each question. Maximum time for test is 5 hours. A 10-minute break is mandatory after 2 hours; an optional 10-minute break may be taken after another 1 Vi hours.
	The test will stop when any one of the following occurs:
	A "pass" or "fail" determination can be made. The maximum number of questions has been taken. The test has lasted for 5 hours.
	The Computer
	Computer experience will not be necessary. Estimated ability is recalculated after each question until it is precise enough to determine whether the candidate is above or below mini mum competence level, in all areas of the test plan. The test will stop as soon as this is determined. Example: The first question is of a fairly easy level. The candidate answers correctly, so the computer estimates that the candidate's ability level is above the level of this question and selects a harder question; or if the candidate answers incorrectly, it selects an easier question, to pinpoint where the candidate's ability level lies, in each area of the test plan.
	CAT: How it works
	Stands for "computer adaptive testing "Adaptive" because the computer estimates the candidate's ability after each question; the next question is chosen based on the candidate's estimated ability so far. The test is therefore "adapted" to each candidate; everyone takes a different, "customized" test. Candidate receives a brief orientation in the use of the mouse and on-screen calculator with sample questions before beginning the exam.


	1. How many questions will there be?
	You will take anywhere from 75 to 265 multiple choice questions.
	2. Where do the questions come from?
	The state boards of nursing nominate item writers, who must meet various criteria.
	3. Will there be questions involving conditions with which I may not have had experience in my nursing program?
	Most of the questions are about patients with conditions familiar to you and are representative of common health problems on a national basis. Some questions may relate to nursing problems with which you may not have had prior experience; their purpose is to test your ability to apply knowledge of specific principles from the physical, biological, and social sciences to new situations.
	4. Can a question have more than one answer?
	No. Only one of the four options is the best answer. You will not be able to choose more than one option as your answer.
	5. Will I get partial credit for selecting the next-to-the-best answer?
	No. Your answer will be treated only as correct or incorrect.
	6. If everyone takes a different test, how can it be fair?
	Each candidate is tested according to the same test plan, and the same passing standard. It may simply require more items to reach a stable pass/fail determination for one candidate, while another may require fewer questions to demonstrate competence level.
	7. Do diploma, associate, and baccalaureate graduates all take the same test? What about graduates from schools outside the United States?
	All candidates are held to the same test plan and passing standard, and take the "same test." (Of course, due to the nature of CAT, each will receive an "individualized" test, without regard to degree, or to state or country of education.)
	8. Does the exam differ by state?
	The exam is a national exam; all candidates are held to the same test plan and passing standard, and take questions from the same pool. (Again, through CAT, each candidate receives an "individualized" test, but without regard to state.)
	9. How is the exam different from the old "paper-and-pencil" test?
	The purpose, test plan, and nursing knowledge and skills tested did not change significantly with the advent of CAT (there were minor adjustments to the test plan in October 1995, unrelated to the change to computer testing). The main differences lie in the efficiency of the computerized testing (maximum of 5 hours and 265 questions, compared to the old 2-day test with up to 372 questions) and the adaptive nature, which precludes skipping questions and changing answers.


	1. Can I skip questions?
	No. You must answer each question in order to move on to the next. You also will not be able to return to previous questions to try them again or change the answer (because subsequent questions are administered based on previous answers).
	2. What if I just don't know the answer?
	You will need to answer the question in order to move on to the next question.
	3. When will I know my results? Will the computer tell me?
	You will not learn your pass/fail status at the testing center; the results will be communicated directly to your state board of nursing, who will mail the results to you. The time frame may differ from state to state, but most candidates should receive their results within 2 to 4 weeks after taking the exam. NOTE: Taking only the minimum number of questions, or taking the maximum, is not an indication of whether you have passed or failed. It merely indicates that a lesser, or greater, number of items was required to reach a determination.
	4. What percentage must I answer correctly to pass?
	Because of the nature of CAT, a percentage rate is not used to determine passing or failure. The test determines whether you are above or below standard competence by determining not the number of questions you answer correctly, but rather the difficulty level you can consistently answer correctly. The process of administering harder or easier questions, continues until you reach the level where you answer approximately 50% of the complex questions correctly. NOTE: When practicing with questions of mixed difficulty, such as those in this review, you may wish to use 80% correct as a "benchmark" goal for yourself.
	5. If I do not pass, can I retest only those areas of the test plan in which I tested poorly?
	No. The whole exam is on a pass/fail basis.
	6. Can I repeat the exam before I get my results?
	No.
	7. How many times can the exam be repeated, and when?
	The National Council allows you to repeat the exam a maximum of four times per year, but not more than once in any 90-day period; however, each state board may set its own, more restrictive time limits and retake requirements.
	8. Who grants the nursing license?
	The license is granted by the state board of nursing to which you applied and for which you took the exam.


	A. Test plan
	Client needs are the bases, or "dimensions," for the test plan. Health needs of clients: The test plan primarily emphasizes meeting the clients' physical needs in actual or potentially life-threatening, chronic, or recurring physiological conditions and the needs of clients who are at risk for complications or untoward effects of treatment. Subcategories include (1) basic care and comfort, (2) pharmacological and parenteral therapies, (3) reduction of risk potential, and (4) physiological adaptation. The second two highest categories of emphasis are safe, effective care environment which focus on (1) management of care and (2) safety and infection control; and health promotion and maintenance, covering (1) growth and development throughout the life span, and (2) prevention and early detection of disease. Finally, 10-22% of the test plan concerns psychosocial coping and adaptation in stress-and crisis-related situations throughout the life cycle. Nursing process (nursing behaviors): The exam integrates steps of the nursing process, as applied to client situations from all stages in the life cycle and to common health problems in all the major health areas and based on current morbidity studies. Levels of cognitive ability: Most items are at the application and analysis level (application of principles, ideas, theories; and analysis of data to set priorities and see relationships), but include knowledge and comprehension. Categories of nursing knowledge and other concepts that are commonly tested: Caring ways by which nursing can assist individuals to maintain health and cope with health problems. Communication Effect of age, sex, culture, ethnicity, and religion on health needs (sociocultural components) are integrated into all units. Documentation; legal and ethical aspects of nursing, accountability. Self-care. Teaching-learning (see health teaching sections [after the conditions'] that are part of Nursing Care Plan/implementation). Nursing fundamentals. Nutrition and diet therapy. Pharmacology. Communicable diseases. Natural and behavioral sciences. Normal growth and development. Basic human needs. Individual coping mechanisms. Actual or potential health problems. Life cycle. Patient environment (protection from harm against airborne irritants, cold, and heat; identification of environmental discomforts such as noise, odors, dust, and poor ventilation; elimination of potential safety hazards; maintenance of environmental order; and cleanliness).
	B. Development
	The Examination Committee of the National Council prepares the test plan, which is approved by the delegates representing the state boards of nursing. It is designed to reflect the knowledge and skills needed for minimum competence by a newly licensed nurse to be a safe and effective practitioner in entry-level nursing, as determined by studies of nursing practice (performed every 3 years to reflect current nursing practice). State boards take turns nominating item writers (faculty, clinical nurse specialists, or beginning practitioners); the Board of Directors of the National Council then selects from this group those who meet the criteria for item writing based on expertise in a particular area of nursing, type of nursing program, credentials, regional balance, etc. The item writers write questions based on common clinical situations and according to the test plan. Then the questions are researched and reviewed by a panel of experts (nominated by the state boards), by those state boards that choose to review, and by the National Council's Examination Committee. Finally, the questions are field tested to eliminate questions that may be ambiguous, irrelevant, or not equally applicable to all regions of the United States. (Each candidate taking NCLEX will take 15 of these "tryout" questions, mixed in with the regular questions; they will not count toward that candidate's performance.) The data gained through field testing are also used to analyze and determine the difficulty level of a question.
	C. Passing standard
	The passing standard is criterion referenced; this means that there is no fixed percentage of candidates that pass or fail. Passing depends solely on performance in relation to the level of minimum competence. The passing standard is reviewed every 3 years.