National Council Licensure Exam (NCLEX) · What Is It, Test Takers, and More

The NCLEX, also known as the National Council Licensure Examination, is a state board exam required for the licensure of nurses in the United States, Canada, and Australia. A passing score on the NCLEX allows graduates to begin practice as entry-level nurses. 

The NCLEX is a computerized exam taken at Pearson VUE testing centers. All NCLEX examinations use Computerized Adaptive Test (CAT) technology to score the exam. With this technology, a computer selects which questions a candidate is asked based on their performance on the previous question. The first question of the exam is relatively easy—below the level of minimum competency. If the candidate answers correctly, the computer selects a more challenging question. If answered incorrectly, a slightly easier question is provided. By continuing to do this throughout the exam, the computer can determine the candidate’s level of competence. 

The NCLEX is taken by nursing graduates who have completed an accredited program at a state-approved nursing school. There are two variations of the NCLEX, one for registered nurses (NCLEX-RN) and one for practical nurses (NCLEX-PN). However, the registration process and exam content are similar. For registered nurses, prerequisites include completing a Bachelor of Science in Nursing (BSN), an Associate Degree in Nursing (ADN), or a diploma from an accredited nursing program. For practical nurses, prerequisites include a diploma from an accredited practical nursing program.  

The first step in registering for the NCLEX exam is applying to the National Council of State Boards of Nursing (NCSBN). Some states have combined registration for the NCLEX exam and the nursing licensure. In contrast, in other states, candidates must apply for licensure with the Nursing Regulatory Body (NRB) in the state they wish to become licensed. To become eligible, candidates must apply for licensure and registration with the NRB, followed by registering and paying the exam fee with Pearson VUE.  Once eligibility is granted, they will receive an email with the Authorization to Test (ATT), which allows candidates to schedule the exam appointment. Each ATT is only valid for a period specified by the NRB, with an average length of 90 days. 

The NCLEX covers a wide range of material based on four primary client needs: physiological integrity, safe and effective care environment, health promotion and maintenance, and psychosocial integrity. All of the content areas of the exam are integrated. Therefore, NCLEX tests the candidate’s ability to think critically about nursing care decisions. 

The physiological integrity category is the most important part of the NCLEX exam, and it includes questions related to adult medical and surgical care, pediatrics, and gerontology. Questions on safe and effective care environment are related to safety issues, medication administration, dosage calculation, nursing procedures, and ethical and legal nursing problems. Questions on health promotion and maintenance deal with female care, pregnancy, labor, and delivery, as well as newborn care and children's growth and development. Finally, questions on psychosocial integrity are related to mental disorders and psychosocial problems, as well as substance abuse and therapy through communication.  

The length of the NCLEX exam varies for each candidate. Because each question depends on how the previous question was answered, candidates can be given between 75 and 145 questions. Some candidates will be asked fewer questions because their passing or failing score can be determined quickly, as they consistently answer questions significantly above or below the passing standard. Candidates with competence near the passing standard may be asked more questions to determine their level of competence.  

Candidates can take breaks during the exam (e.g., stretching, restroom, etc.). Regardless of the number of questions administered, each candidate will have five hours to complete the exam, including all break time as well as a short introductory screen. Two optional breaks are scheduled within this time frame, one after the first two hours of testing and another after three and a half hours. 

Most questions on the NCLEX exam are multiple choice answers with a single correct answer. However, starting April 2023, the National Council of State Boards of Nursing (NCSBN) has introduced a new format for the NCLEX exam. The Next Generation NCLEX exam includes a new case study-based format designed to promote critical thinking and clinical judgment, as well as 15 new types of questions (e.g., fill-in-the-blank, hot spots, chart/pictures, drag-and-drop, select all that apply, etc.). 

Several platforms provide test plans with sample practice questions to help candidates achieve their best results in the NCLEX exam.  

The NCLEX exam is not a pass or fail exam based on the candidate’s score. Instead, the computer stops giving questions when it is 95% certain that the candidate’s ability is clearly above or below the passing standard. If the candidate’s knowledge is very close to the passing standard, the computer continues to give questions until the maximum number of questions is reached. At this point, the computer disregards the 95% confidence rule and decides whether a candidate passes by their final ability estimate. The final ability estimate is computed from all responses to all the questions completed on the exam. If it is above the set standard, the individual passes. If a candidate runs out of time before reaching the minimum number of questions, or their final ability estimate is below the set standard, the result will be a fail. 

Candidates may obtain unofficial test results within two business days after the exam. However, official results can take up to six weeks, depending on the Nursing Regulatory Body. Candidates who do not pass the exam will receive a performance report showing how well they performed in each test content area. Candidates who fail the exam can use this report as a guide to prepare them to retake the exam. Individuals who wish to retake the NCLEX must wait at least 45 days before retaking the exam. There is no limit to the number of times a candidate can do the NCLEX exam, but individuals may only take the exam eight times per year.