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What Is the Difference Between the HESI & NCLEX Exam?

by Laura Fletcher

Nurses are often on the go, providing the critical personal care necessary to patients’ survival. However, students training to become nurses must take a lot of impersonal tests to become licensed. Two key exams, the HESI and the NCLEX, evaluate students at the start and culmination of their nursing education: the HESI to get into nursing school and the NCLEX at the end of nursing school to obtain licensing as a registered or practical nurse.

Preparing for the HESI

The HESI exam is developed by the Health and Environmental Sciences Institute and is taken to enter a nursing degree program. Typically, a student nurse will have completed the basic science and general education courses required of all nurses before attempting the HESI. These include college-level mathematics, psychology, a year of English, a year of general chemistry and a year of anatomy and physiology. Once a nursing student has demonstrated this basic knowledge, she may start taking classes that cover the elements of nursing practice, such as advanced surgical nursing or pharmacology.

Elements of the HESI

The HESI lasts 5.25 hours and consists of seven sub-exams. These include Reading & Comprehension, Vocabulary & General Knowledge, Grammar, Basic Math Skills, Biology, Chemistry, and Anatomy and Physiology. There is also a brief section that tests the student’s learning style and personality type. The majority of the test is focused on the first three language-oriented exams, with 50 questions each. The last three science exams have a secondary weight of 25 questions each. The math section contains 50 questions.

Preparing for the NCLEX

The NCLEX exam is developed by the National Council of State Boards of Nursing and is the licensing exam for all registered and practical nurses. The NCLEX covers all of the knowledge a nurse acquires over the course of her training, from basic anatomy, physiology and chemistry to diagnosis and clinical procedures, and is based on the five steps of nursing: assessment, analysis, planning, intervention and implementation. Each of the questions on the NCLEX addresses one of these five steps. To prepare for the NCLEX, review all of the material you have learned in your nursing classes. For further preparation, explore study preparation guides and flashcards online or in bookstores.

Elements of the NCLEX

The NCLEX exam is usually taken on a computer, and whether a test taker answers a question correctly determines the difficulty level of the next question. The test determines how well the test taker knows the standard of care, and all nurses must demonstrate the same basic level of knowledge to pass. The majority of the questions on the NCLEX, roughly 43 to 67 percent, address issues of physiological integrity, such as the effects of different diseases, the effects of aging, procedures for treating injuries and signs of child abuse. Twenty-one to 23 percent of NCLEX questions test knowledge of the elements of a safe care environment, such as safety measures against injury and infection, laboratory test results and administering pharmaceuticals. Health promotion and maintenance-related questions make up roughly 12 percent of the exam and address issues such as proper diet and care of newborn infants. Finally, 12 percent of NCLEX questions pertain to psychosocial integrity and test the future nurse’s knowledge of best practices for dealing with mentally ill patients.

About the Author

Laura Holland Fletcher has graduate level training in ESL, linguistics and the teaching of writing. She taught ESL and college writing for more than 10 years in both the US and Asia. She also writes for local and national magazines that cover legal, educational and social justice issues.

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