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How Difficult Is the NCLEX?

by Erica Loop

In theory, nursing school should prepare all graduates to enter into professional practice with the skills and knowledge to provide superior care. As a way to ensure that the general public receives the best nursing care possible, the National Council of State Boards of Nursing requires every registered nurse licensee applicant to pass the NCLEX. Given the weight of this test -- you can't become an RN without passing-- many nursing school grads wonder how difficult it is.

Changing Content

Although the basic content -- nursing care knowledge -- is on every version of the exam, the test changes slightly each year. The NCSBN analyzes what areas of practice entry-level nurses engage in most on a yearly basis. This data affects the type and amount of questions on each yearly revision of the NCLEX. While this doesn't mean that this year's exam is drastically more difficult than last year's, it does mean the percentage of test questions in each area of practice may change from year to year. The NCLEX Test Plan provides test-takers with the breakdown of exam questions for the current year. For example, in 2013 between 17 and 23 percent of questions were on management of care, 12 to 18 percent were on pharmacological and parenteral therapies and 9 to 15 percent were on reduction of risk potential. If your year's test includes a larger percentage of questions in an area you don't excel in, you may find the exam more difficult.

Professional Practice Areas

The NCLEX includes test questions in different nursing areas that are each essential for professional practice. All of the NCLEX test content areas include subject-specific material that you should have already learned in nursing school. While the percentages of content areas vary by year, the core types of questions stay the same. The main areas break down into different types of client needs: safe and effective care environment, health promotion and maintenance and psychosocial integrity. The content further breaks down into subcategories such as basic care and comfort, pharmacological and parenteral therapies, reduction of risk potential, physiological adaptation, safety and infection control and management of care.

Adapting for the Test-Taker

Unlike the static paper and pencil tests of the past, the modern NCLEX is a "computer adaptive" exam. Computerized adaptive testing, or CAT, allows the computer to assess your answers on the exam, changing the subsequent questions to align with how well you're doing. CAT allows the computer to select questions that you'll have at least a 50 percent chance of getting right, based on your prior answers. This helps to ensure the test isn't too easy, or too difficult, for any one test-taker. For example, if you're getting consistent correct answers, the questions may become more difficult. On the other hand, if you are missing question after question, the computer will adjust the difficulty level and make them easier.

Percent Passing

Not every future nurse will pass the NCLEX on the first try. Reviewing pass-rate statistics can help you to get a better picture of the difficulty of the test. The NCSBN publishes an online version of the pass-rate statistics for each test-taking year. The statistics show the pass rates per quarter of the year, as well as the year in whole. Additionally, you can view the pass rates by degree program -- such as diploma, bachelor's or associate. For example, in 2012 the overall pass rate for first-time NCLEX-RN test-takers was 90.34 percent. Statistics also show the percentage of repeat testers who pass the NCLEX. In 2012, 55.63 repeat test-takers passed the exam.

About the Author

Based in Pittsburgh, Erica Loop has been writing education, child development and parenting articles since 2009. Her articles have appeared in "Pittsburgh Parent Magazine" and the website PBS Parents. She has a Master of Science in applied developmental psychology from the University of Pittsburgh's School of Education.

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