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Ask an Expert: Guide to the NCLEX


Learn what to expect from the NCLEX with this advice from an Ameritech instructor.

If you’re a nursing student, you know that graduation is not the end. After you get your degree, you’ll have to take the NCLEX, a national nursing test administered by the National Council of State Boards of Nursing and graduates must pass the test to become a registered nurse. 

We talked to Stephanie Greenwood, Ameritech’s NCLEX instructor and assistant director of didactics in the ADN program, to get the inside scoop on the test that every nurse has to pass.

What is the NCLEX?

It’s a national test that’s administered to any candidate who wants to become an LPN or RN. A lot of people know what law boards are. It’s very similar to that, and it’s one of the hardest boards you can take.

We qualify all of our students to become an RN. We prepare our students so they have all the competencies, and can pass on the first try. Last year we were at 88.5 percent passing, which is high—and when you talk about pass rates you talk about first-time pass rates.

Related Resource: 10 Common Types of NCLEX Questions

What is on the NCLEX?

There’s an NCLEX testing plan that breaks it up by subject matter, but it’s really more based on types of subject matter. For example, one of the areas is basic care and comfort. Another area might be pharmacology. Another might be safety and infection control.

Each area is weighted by how many questions are based on that area. They weight things based on where they feel an entry-level nurse will be starting. Right now, that means a lot of med-surg. Medical-surgical floors are where most of our new grads are starting, so there’s going to be a lot of med-surg on the test.

Related Resource: 7 Essential NCLEX Study Tips

How long is the NCLEX?

It really depends on the student. The computer is really smart and it goes by the percentages we were just talking about. It makes sure that every test meets a certain criteria, and it also makes sure your test is not too hard or too easy.

On the RN test you can get anywhere from 75 questions to 265 questions. If the student gets the former, the computer has determined in 75 questions one of two things: Either they really know their stuff and they’ve shown that they’re above the minimum competency, or they really don’t know their stuff and they need to study quite a bit more.

If a student got all 265 questions, that would mean they are really straddling the competency line. The NCLEX algorithm is complicated, but it’s a very smart, adaptive test. After you get past 75 questions, once it determines whether you’re above passing or below passing, it will shut off.

We have quite a few students who pass with 75 questions, and some go through all 265. I would say maybe around 125 is the average number of questions our students see, but I’m guessing on that.

Related Resource: Nursing Lab Values to Know

How is the test formatted?

There are quite a few types of questions. Multiple choice is the most common one. It can also have “select all that apply.” Those usually have five options, and you could have to select just one or all five. They also do things called hot spots. That’s where you’re given a diagram of the human body, for instance, and you’re asked where you’d put your stethoscope.

They also have dosage calculations which are usually fill in the blank, so you have to calculate the dosage amount and you have to fill in your answer. There are also questions where they give you a chart and you have to answer a question based on that. And they do drag-and-drop questions where you have to put things in order. Multiple choice, though, is still the most common question.

How often is the NCLEX rewritten?

We have a major test change every three years. While they’re always updating content and making sure best practices are up to date, they only change the test blueprint every three years. It takes quite a bit of time for a question to become an official NCLEX question.

If you don’t pass, you can take it again, but there is a 45-day waiting period between each attempt.

If you do pass, you won’t find out immediately. It can take up to 10 days but most of my students know in a day or two.

Related Resource: 6 Common NCLEX Mistakes to Avoid

What happens if I don’t pass? What happens if I do?

If you don’t pass, you can take it again, but there is a 45-day waiting period between each attempt.

If you do pass, you won’t find out immediately. It can take up to 10 days, but most of my students know in a day or two.

What types of questions do students have the most trouble with?

It is a learned question style. Instead of asking “What color is the sky today?”, it would say something like “Sally is outside playing in the park, and it’s May with some scattered clouds, and there’s no rain in the forecast. What color is the sky?” It’s going to give you a lot of extra information that we call distractors, and the student needs to learn how to go through those distractors and figure out what’s going on and what the question is actually asking.

We start students out on day one with those types of questions and teach them how to dissect them. As long as they know the context, they should be able to answer the question.

Do you have a favorite type of NCLEX question?

They call them negative questions. It’s asking the student to find the information that’s incorrect. The reason why I like them is that there’s only one correct answer, but it’s actually the wrong answer. The majority of NCLEX questions are actually designed so a student can get it down to a 50/50 choice and then make an educated guess.

The nice thing about a negative question is that there shouldn’t be a 50/50. They should just be able to find the answer, and they are a little bit harder because our brains don’t work that way. We want to find the correct answer, not the negative answer.

Do you have a least favorite type of question?

Yes, and it’s the same one that all of our students dislike, and that’s the “select all that apply” questions. You don’t know how many answers are correct. Two may be correct, or four, or five. You don’t know, and you can’t use the process of elimination. It’s like a 5-part question, and you only get credit for one question even though there are five parts to it.

What advice do you give as an instructor?

One of my biggest pieces of advice is for them to learn to trust themselves. Our students have a really tough time with that. They want to second-guess themselves or say “Well, I’m really not sure if that’s right.” What I always tell my students is if you’ve studied it, you know it. One of the biggest things I see with students is that they’ll convince themselves they need to change their answer. And the majority of the time when they change their answer, they’re changing it from a correct one to a wrong one. You need to trust your gut.

Passing the NCLEX takes time, teamwork, and dedication. Stay in touch with the Ameritech community by following us on Facebook, and be sure to download our free ebook 49 Proven NCLEX Strategies. Happy studying!