As graduation approaches, you may be filled with anticipation and fear about what lies ahead: new jobs, changing roles, and unknown possibilities. You face the additional challenge of the NCLEX-RN examination, and you may fear failure, which can be particularly overwhelming.

Compounding these fears are rumors and misconceptions regarding the NCLEX-RN. This article provides information to nursing students and educators in an effort to dispel misconceptions and to answer some of the more frequently asked questions from candidates regarding the exam. Following are questions by students about the exam and replies from the authors.

1. What is the National Council of State Boards of Nursing (National Council), and what is its importance to nursing?
The National Council was formed in 1978 and consists of 61 boards of nursing across the United States, including the District of Columbia, the Virgin Islands, Puerto Rico, Guam, American Samoa and the Northern Mariana Islands. Its mission is to lead in nursing regulation by assisting member boards, collectively and individually, to promote safe and effective nursing practice in the interest of protecting public health and welfare. Through the National Council, these 61 Member Boards develop and establish policies and procedures regarding licensure examinations in nursing, identify and promote uniformity in standards and outcomes in nursing education and practice, and assess nursing trends and issues. Although there is one standardized nursing examination for candidates, individual states still maintain their own standards for nursing practice to which nurses must qualify and adhere.

2. How is the NCLEX-RN examination constructed?
Every candidate’s examination conforms to the NCLEX-RN which controls inclusion of important nursing content. The test plan serves as a blueprint in the construction of the examination. The new NCLEX-RN Test Plan became effective in April 1998. All examinations, regardless of their length, have the required proportion of questions or items from each area (category) of the NCLEX Test Plan. These areas include: Safe and Effective Care Environment; Health Promotion and Maintenance; Psychosocial Integrity; and Physiological Integrity. The content represented in the test plan is based on the results of a job analysis that is repeated every three years. Nurses who have been on the job for just six months report to the National Council the type of tasks for which they are responsible, how often the tasks are performed, and the priority of these tasks. These data are combined into an importance weighting for each task. The tasks are combined into content areas, and their importance weights summed. The National Council reviews the resulting content area weights, adjusts them based on a professional assessment of current nursing practice and individual state licensure, and those become the test plan weights. The National Council’s Delegate Assembly (an annual meeting of the 61 licensing jurisdictions in the United States and its territories) votes on the final test plan.

3. Who writes the questions?
The NCLEX-RN examination questions are written by masters or doctorally prepared nursing experts who work with RNs or teach RN students. The nurses who write the questions are called "item writers." In order to participate on an item writer panel, nurses must currently work with nurses who have graduated from nursing programs within the last twelve months, or they must teach nursing students.

After the questions are written, they are reviewed by a second panel called "item reviewers." This is an all RN panel for NCLEX-RN examination items. An advanced degree is not required for the item review panel. The National Council tries to get a wide representation of nurses to participate on the item review panels. The United States and its surrounding territories are divided by the National Council into four geographic areas. It is important that each item development panel is composed of nurses representing each region, a variety of practice areas, and minority populations. The entire item development process ensures that the NCLEX-RN examination represents current nursing knowledge, skills and abilities, and is the best assessment of an individual’s competence to practice entry-level nursing.

As you progress through your nursing career, consider the opportunities provided by the National Council that are available for you and your nursing colleagues.

4. I didn’t realize that I was losing test-taking time during breaks. How many breaks are allowed?
The five-hour time limit for the examination starts when you sit down at the computer workstation and begin the tutorial. A ten-minute rest break must be taken after two hours of testing. Candidates have the option of an additional ten-minute break following three and one-half hours of testing. The computer notifies the candidate when it is time for these two scheduled breaks. All break time (both scheduled and unscheduled) is included in the maximum five hours allowed for the examination. Candidates may take as many breaks as needed. However, testing time continues to run during each break that is taken.

5. I’m afraid that five hours is not enough time for me to take the NCLEX-RN examination. Will I fail if I run out of time?
If your examination ends because your five hours expired, the computer did not have sufficient evidence to make a clear pass or fail decision (or it would have already stopped administering questions). Candidates whose competence is either far above or far below the passing standard are identified quickly, and their examinations end after the minimum number of items have been administered. Candidates whose competence is closer to the passing standard (neither extremely high nor low) need to provide more information (by answering more questions) before a confident decision can be made. By using Computerized Adaptive Testing (CAT) methodology, the NCLEX examination is capable of producing as precise a measurement using the maximum number of items (only 265), as was done using the paper and pencil format.

However, when a candidate runs out of time before taking the maximum number of questions, the computer reviews the candidate’s responses to the last 60 questions to determine a pass or fail result. If each of the last 60 competence levels that were calculated are above the passing standard, then the candidate will pass the examination. This does NOT mean a candidate needs to answer all of the last 60 questions correctly, but enough of them correctly so that one’s competence level stays above the passing standard. Therefore, if a candidate’s performance has been consistently above passing, the candidate will pass, despite having run out of time

Candidates should plan to keep a steady pace when taking the NCLEX-RN examination, averaging about one minute per item, on the assumption they may need to take the maximum number of questions.

6. I’m worried because I got the long version of the exam. Is it true that some candidates randomly receive a maximum length exam?
It is false that some candidates randomly receive a maximum length examination. The length of an NCLEX-RN examination is based on the individual performance of the candidate on the examination.

7. Several questions on my NCLEX examination asked the same information. Did I receive similar questions because I answered incorrectly the first time?
Each examination is designed to meet all requirements of the NCLEX test plan. The examination is constructed to recognize that each candidate has strengths and weaknesses in particular subject areas. It is not designed to administer a rephrased question for questions answered incorrectly by candidates.

There are several reasons candidates may receive questions that appear to cover similar content areas. Candidates may have received "tryout" questions (questions that are imbedded in the examination which do not count, but are used in future exams as real questions), or questions in which the content was similar but the question covered a different "Client Needs" category.

8. Why do some states have a higher passing standard for nursing licensure, like California or New York?
All states accept the National Council recommended passing standard for the NCLEX-RN examination or NCLEX-PN examination to be eligible for nursing licensure. California and New York do NOT require a different passing standard on the NCLEX-RN or the NCLEX-PN examinations for initial nurse licensure by examination.

9. Why can’t I get my results immediately after taking the exam?
Candidates do not receive NCLEX-RN examination results at the testing site. After a candidate’s results are reviewed and analyzed, they are mailed to boards of nursing within 48 hours after the exam is completed. Results are then forwarded on to the candidate by the board of nursing where the candidate requested licensure. The specific method for the processing and distribution of candidate results is different for each individual board of nursing, so the exact time for receiving results is different from state to state. The board of nursing, not the National Council, is responsible for releasing examination results to candidates. Generally, candidates receive pass or fail results in approximately four weeks.

10. I’m interested in the passing statistics for the United States and its territories. Where can I find this information?
National NCLEX examination passing statistics can be accessed through the National Council’s web site. Look under NCLEX Examination Info for the percentage of candidates who passed. Result statistics are divided by either RN or LPN/VN examinations.