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Where do I buy NCLEX review materials?

Many companies provide NCLEX review materials, all of which you can purchase online. There are quite a few options, from just utilizing one book, to a self-guided online review, to test taking strategies, to an in-person review. What to buy really depends on your specific educational needs.

Consider:

  • How do I learn best? Audio, video, printed, in-person
  • Do I want something I can utilize on mobile?
  • What can I afford?
  • Do I need test taking strategies in addition to content review?
  • Do I want access to practice questions? (Spoiler alert: YES)
  • Do I want to take a simulation NCLEX?

There are many companies out there who provide review material. Hurts, ATI, Kaplan, NRSNG Academy, the NCLEX Mastery App, and the NCSBN all provide different NCLEX review options with varying levels of support and guidance. Check out their specific websites or go to NRSNG.com/Academy for a comparison chart.

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Where will I send my NCLEX application?

Buckle up. This can be a little confusing.  First of all, the majority of this paperwork is done online.

First, you must register with the state board of nursing located in the state you woud like to practice in.  This specific state board of nursing will determine if you are eligible to take the exam in the first place. They typically do the background check and require you to submit fingerprints. Being a nurse is not just passing the NCLEX, you must also be deemed appropriate for licensure.  (There are people who can pass the NCLEX, but it wouldn’t be appropriate to grant them a license… say they were convicted of some major offense which would deem them ineligible. Typically those kinds of things would prevent someone from entering nursing school in the first place, but it’s important to have these application safeguards in place.)

Let’s go through an example. If I want to work as a registered nurse in Texas, I would go to the Texas Board of Nursing website and look for an option to apply for the NCLEX.  I then complete and this application form, pay the fees, and submit the required paperwork and documentation.

Next, once I have applied in Texas, I would then register with Pearson Vue (no matter which state I want to work in).  Pearson Vue is essentially the company who administers the NCLEX. Here is where I would go to create an account with Pearson Vue. I would register with them, and again pay fees. (Blerg.)

Once I have completed both of these steps (applying with your State Board of Nursing and registering with Pearson Vue), I must wait. I must wait until I receive an email with my Authorization to Test (also known as an ATT).

This document essentially communicates that you are eligible to test for the NCLEX from the perspective of your state board of nursing. You MUST have the ATT to schedule a test date.  There are no exceptions. An ATT is typically only good for 90 days. If you don’t want to test for 6 months (which we do not recommend, test as soon as you’re ready), don’t go through this process now.  Wait until you’re closer to when you would like to test.

Finally, after receiving your ATT you may schedule your NCLEX test day.  You can do this online or via phone (we recommend scheduling online). You basically sign into your previously created Pearson Vue account, and schedule a date.  They will provide a list of dates and locations.  It is essential you schedule your test date as soon as possible after you receive your ATT.  Remember, the ATT’s expire, so if you wait to schedule until near your expiration date, they cannot guarantee that you can test before it expires.

Checklist:

  1. Apply with your state board of nursing
  2. Register with Pearson Vue
  3. Wait for your ATT
  4. Receive ATT
  5. Schedule your test date with Pearson Vue
  6. Test!

Check out Ruwix to learn the solution of the Rubik's Cube and other twisty puzzles like Pyraminx, Square-1 etc.

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Where will I take the NCLEX?

You get to choose where you take the NCLEX!  Whenever you’ve received your ATT and go online (or call) at Pearson Vue, they will give you options of locations near where you live as well as testing times. Where you go is completely up to you and doesn’t even have to be in the same state you will practice in. Consider how long it will take to get to the testing center when selecting a test time.  So if it will take you two hours to drive to this location, consider that when selecting an 8:00 am test time.  There are many test centers all over the country. Click here to enter your zip code to see what’s near you. You may do this at any time.

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Where to check NCLEX results?

While this exam is taken on a computer, they do not instantly provide results.  This is very intentional, as they want to be extremely cautious and ensure everyone who the computer says “passed” actually did pass. They do not want to give someone a nursing license who didn’t actually pass, but a computer error said they did.  Therefore, every single exam is scored twice.

In some states, can find out if you passed in as little as 48 hours. This is called the “Quick Results Service”. Click here for a list of participating states. You go to the Pearson Vue website, log into your account, select “Quick Results,” pay a fee (ugh) and they will give you unofficial results. However, this does not authorize you to practice as a nurse.

Only your state board of nursing can release official results, and the processes for notifying people may different.  However, most states mail official results within six weeks.

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Where do NCLEX questions come from?

The NCSBN (National Council of State Boards of Nursing) comes up with the content for the NCLEX and also creates the passing standard. Every three years, the NCSBN basically analyzes how entry-level nurses practice. The questions on the exam are written by practicing nurses, which are then reviewed by a second panel of nurses, based on what an entry-level nurse should know to safely practice. These questions are then pre-tested before being allowed to be officially part of the examination. Source.

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Which states require the NCLEX?

All 50 states require the NCLEX.

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Which NCLEX review is best?

There are various options for NCLEX reviews, some are merely a print book, some are an online question database, some are a database and book, and some provide an in-person course, book, and database.  What is “best” really depends on your needs.  Some people only need to review a bit of content, take a handful of questions, and they’re ready. Some people need a formal review and additional resources. At NRSNG, we’ve created an entire academy of resources as well as a massive database of NCLEX review questions.

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Who administers the NCLEX exam?

The National Council of State Boards of Nursing (NCSBN) writes the NCLEX, while Pearson Vue administers it.

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Who writes NCLEX questions?

The National Council of State Boards of Nursing (NCSBN) writes the NCLEX.  Currently practicing nurses write the questions based off of the previously established standard (that is routinely reevaluated), which are then reviewed by a second panel of nurses. After this, the questions are then pre-tested before being allowed to be officially scored in the NCLEX.

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NCLEX: who to see first questions / which patient do I see first?

These are also known as patient prioritization questions. There will be clues within the question to help you determine which patient is your number one priority.  

Prioritize in this order: ABC’s, Pain, Education, Feelings.  With ABC’s, consider which option is the closest to airway.

Things to help you determine who to see first include…

  • Safety – are any of the patient unsafe?
    • Example: is one of the patients at risk for falling, or has a patient with a risk for suicide been left alone?
  • Confirmed – are we worried about the potential for problem or are we dealing with a confirmed problem?
    • Example: Concerned about hypotension versus a patient who is has confirmed hypotension right now
  • Normal response – is this a normal response to this situation, or is it abnormal?
    • Example: are we concerned about absent breath sounds in the right lower lobe, or not so much because they had a lobectomy 2 days ago?

We created a course dedicated solely to test-taking skills and cover patient prioritization questions specifically .  It’s part of our NRSNG Academy!

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What does NCLEX stand for in nursing?

National Council Licensure Examination

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What are NCLEX questions like?

There are different kinds of NCLEX questions. You have both the standard 4-option multiple choice questions with one answer, and alternate format questions.

RELATED WEBINAR: Test Taking Webinar

A standard multiple choice question looks like this:

So, what are you doing right now?

  1. Reading the NCLEX FAQ’s
  2. Pretending I’m Carla from Scrubs
  3. Making cookies
  4. Working out

Alternate format questions are any of the following:

  1. Select all that apply: at least two answers are correct
  2. Ordered response: you put the answers in the correct order
  3. Charts: you are given a chart, or exhibit, and have to analyze that to provide the appropriate answer
  4. Audio: you must listen to an audio file and select the correct answer based off of what you heard
  5. Fill in the blank: a word will be missing and you have to type in the answer
  6. Hot-spot: you’ve given a picture and have to click on the area that is the correct answer (where you would apply pressure to assess McBurney’s point, for example)
  7. Graphics: your given pictures (like of ECG strips) as answer options and need to select the correct one.

You may get any number of multiple choice and alternate format questions.  You may get more select all that apply, only 1-2 charts, 3 audio, and 2 hot spots.  There isn’t a set order of questions or question types.

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What is the passing NCLEX score?

The NCLEX is a pass/fail exam – but it’s not quite that simple or easy to explain. A passing standard is decided upon by the NCSBN, which is explained in detail here. Basically, there’s isn’t a passing score like your other exams. You can’t just get a “80%” to pass because it is much more complicated than that.

The NCLEX is a computer adaptive test, or CAT for short. (Meow…)  Essentially, everyone’s test is different because it is constantly adapting questions based off of the answer you provided in the previous question, all in an effort to ensure you are answering at least 50% correct at the level of their passing standard.

You are given a question to start with that is essentially medium difficulty. If you get it wrong, it gives you an easier question. If you get it right, it gives you a harder one.  It keeps adapting to your answers (giving you easier or harder questions), until you’ve answered enough correctly to show them you’re above their passing standard.  That’s why some people get the minimum questions of 75 (60 scored, 15 that are being pre-tested and not actually scored), and some get the maximum of 265.

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The NCLEX: what you need to know

Wow. Loaded question here guys, but I’ll try to answer it.

There is a LOT you need to know to pass this examination. You entire nursing school education should be preparing you for it. Here is the actual 2017 NCLEX Test Plan, which discusses the exam in great detail. I highly recommend checking it out.  

Here are the categories of information:

  • Physiological adaptation – 10%
  • Coordinated care – 21%
  • Safety and infection control – 13%
  • Health promotion and maintenance – 9%
  • Psychosocial integrity – 12%
  • Basic care and comfort – 10%
  • Pharmacological therapies – 13%
  • Reduction of risk potentials – 12%

One of the important things to realize about the above list is that is is pretty evenly distributed, with the exception of coordinated care. Therefore, you can’t study all pharmacology and wing the rest. You must have a well-rounded knowledge base to successfully pass the NCLEX. Check out our NRSNG Academy for content that touches each of these aforementioned NCLEX categories and the plethora of NCLEX resources at NRSNG.com!

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The NCLEX: what to bring

Security is tight at testing locations. They really need to ensure that people are who they say they are, and they’re not giving someone an okay to get a nursing license when they shouldn’t. They also must protect the integrity of the exam and ensure no one is copying down questions or sharing information.  

To test, you must ensure you have an acceptable form of identification.  

An acceptable form of identification must include your name exactly as it appears on your authorization to test (ATT).  It also must be current, government-issued, and have your photograph and signature on it. Some examples of acceptable forms of ID include your driver’s license, state ID, or passport. The only acceptable name change documents are marriage licenses and divorce decrees.

This is serious. You will be turned away if you don’t have appropriate identification. And you’ll have to pay again.  

They will take your picture, signature, and palm vein scan. There are no exception, these must be obtained.

You do not need your authorization to test (ATT).

You can bring your keys, phone, and so forth, but if you do, you will be required to store it in a locked container provided by the testing center, who will hold onto it until you’re done. They will make you take off any hats, coats, scarves, gloves, etc. (Religious head coverings are permitted.)

While you can take breaks, you cannot access those of your personal items during. Also, you can bring family, friends, but cannot talk to them until you are done and they must wait outside the testing area.

Basically, bring your acceptable ID (and the name on it must match your ATT exactly) and be ready to provide a signature, have a picture taken, and provide a palm vein scan.

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When was the NCLEX established?

What is commonly known as “nursing board examinations” have been in existence since 1941.  At that time, they were called the “State Board Test Pool Examinations” or SBTPE.  In 1978, the National Council of State Boards of Nursing (NCSBC) was formed, and in 1982 they changed the name of the nursing board examination to the “National Council Licensure Examination” (NCLEX). The test was the same, but the name was changed.  Source.

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When did the NCLEX becoming computerized?

After much testing and planning, the first computerized NCLEX exam occurred on April 1, 1994.  For the previous 53 years, the nursing board examination was administered with paper and pencil, then hand-scored. For many years, it was only offered twice a year, and candidates had to wait as long as six months to find out if they had passed. Source.

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When are NCLEX results posted?

If you choose to find out your via the Quick Results Service and your state provides this service, you can get unofficial results in as little as 48 hours.  You will get your official results from your state board of nursing, typically in approximately six weeks or less.

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Why do students fail the NCLEX?

There are various reasons people fail the NCLEX. When you fail, you are given an NCLEX Candidate Report Performance Report, which tells you in detail where you fell short.  Here is an example of one, from the NCSBN.

 

Reasons people fail

  • Waiting too long: some people wait months and months to sit for boards (typically out of fear of failure or not feeling ready to practice), and the longer you wait, the more you forget
  • Not truly studying: some people glance at a textbook here and there and don’t truly focus on studying, which puts you at a major disadvantage
  • Cramming: there is simply too much information to know for an exam like this
  • Not preparing for the type of questions: NCLEX-style questions are unique, therefore it’s essential not just to study content, but to also get familiar with the style of questions
  • Not preparing for the environment: some people get very anxious, aren’t used to computerized testing, don’t have everything they need together (acceptable form of ID, for example) and show up frazzled and frantic.
  • Not taking the steps they need to set themselves up for success: some people have test anxiety, some have disabilities, some really excel with content but are not great test-takers, some are great test-takers but not great with content, and the list goes on and on.  This test is a big deal and very serious. There is a lot prep work for studying, applying to test, becoming eligible… it’s not something you can show up 25 minutes late to and not study for.  
  • Didn’t go to a great nursing school: you should be preparing for the NCLEX at the beginning of nursing school. Some schools simply don’t appropriately prepare students, which is why you should look at your state board of nursing’s website at NCLEX pass rates at nursing schools when you’re deciding upon where to go. Here is an example of of the 2015 NCLEX pass rates for the nursings schools in Texas. You can go to any state board of nursing website to look for pass rates in your respective state.
  • Not having a study plan: you’ve got to have a game plan for studying and taking practice test questions. You can’t just look glance at a book a few times, or just try to read as many pages as possible. Identifying your weak areas, familiarizing yourself with the exam structure and style of questions, as well as having a studying schedule is absolutely essential to success.

You either pass or fail the NCLEX.  There’s no barely squeaking by. You must prepare appropriately or you will not pass.

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Why does the NCLEX shut off?

The NCLEX shuts off because it has decided that you have either met the passing standard and passed, or not and failed.  You will receive a minimum of 75 questions, therefore if you have demonstrated in those 75 questions (well, 60 questions with 15 being pre-test questions and not actually scored) that you have exceeded the passing standard, it shuts off and you’ve passed.  It keeps evaluating whether or not you’ve met their standard with each and every question, and once it makes a decision, it shuts off. There is a maximum of 265 questions and a 6 hour time limit.  Outside of the minimum and maximum numbers, there is no set number of test questions like there were for exams during nursing school.

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Why are my NCLEX results on hold?

Each examination is scored twice, and the results are given to your state board of nursing.  It is essential that they ensure that make sure the results are accurate and there are no errors.  It takes approximately 6 weeks to get your official results, but you can use the Quick Results Service in as little as 48 hours to get unofficial results if your state participates in this service.
However, the NCSBN may cancel or withhold results if they think something not cool has happened. A few reasons they give here include misconduct, violation of the rules, a testing irregularity, falsifying identification, or irregular activities.

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NCLEX: how long to study?

The amount of time needed to study depends on the individual and their needs.  Taking a pretest after graduation to identify areas in which you need to focus is helpful.  In addition to identifying these areas, it’s also essential to know understand the way the questions are structured.  Start taking NCLEX practice questions and see how you’re doing, then gauge your efforts accordingly.  Taking test prep questions daily is very helpful until test day, with a day off here and there for a mental break.

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NCLEX: how long does it take?

There is no minimum amount of time, but there is a maximum.  The testing centers require you to arrive 30 minutes early. Once your test begins, it’s up to you! The maximum time is 6 hours.  I’ve met people who have passed in 20 minutes, 1 hour, and even 6 hours.  It all depends on how fast you answer questions.

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NCLEX: how much does it cost?

There are a few things to consider when factoring in cost. First, you have to apply to your state board of nursing to apply to become eligible to get your “license by examination”.  Applying to become eligible typically encompases a proessing fee.

 

Examples of fees in a few different states

*Data retrieved April 2017 and may not reflect the most accurate requirements

 

StateFee to apply to become eligible to test
North Carolina$75
North Dakota$130
Delaware$141

 

You may need to also get fingerprinted and send your transcripts in to your respective board of nursing as well, which would also add to the cost.  

 

After you have applied to your respective state board of nursing, you have to get registered with Pearson Vue, the people who administer the NCLEX.  Currently, it costs $200 to register with Pearson Vue (please note this cost is subject to change).
When figuring in state costs and Pearson Vue, a prospective nurse can expect to spend anywhere from $275-$400 to simply sit for boards once.

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NCLEX: how many times can I take it?

You cannot take the NCLEX more than 8 times in one year per the NCSBN.  You must wait 45 days in between attempts. However, you should also look at your respective state board of nursing policy on retakes, as their standards may be different than the NCSBN.

 

RELATED ARTICLE: How Many Times Can I Take the NCLEX?

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Are NCLEX fees tax deductible?

If you are an employee, NCLEX fees would be classified as a “job related expense” and are tax-deductible, according to TurboTax. If you are self-employed (which would not be most brand new nurses), it would be considered a business expense.  Please see your accountant for information specific to your situation. Source.

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Are NCLEX review courses worth it?

Absolutely. After you’ve gone through nursing school and learned a TON of new information, it is really difficult to really focus down onto the information you need for the exam.  Also, most NCLEX review courses provide practice questions, which are absolutely essential to NCLEX success.

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Can I pass the NCLEX without Kaplan?

Absolutely. Kaplan is quite an expensive course and not everyone can afford it.  There are many other options out there, including the one we’ve created at NRSNG which bills you monthly rather than a large lump sum.  Some people only need to do a 5-10 review questions/day until testing. Some need a little more in-depth content review and practice questions, all of which are available in affordable options.

 

One of the main drivers in us starting NRSNG and the NRSNG Academy was because we feel that some of the “other” prep companies are failing in the way they are teaching nursing students.

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Can I take the NCLEX if I have a DUI?

Absolutely.  It is imperative that you disclose your DUI in your application to the state board of nursing. Even if the records have been sealed or expunged, they most likely will discover them.  Basically, just because you have a DUI on your record doesn’t mean the board won’t clear you to test.  However, they will look at each case individually and make a decision. Naturally, reviewing someone’s records with various infractions will take longer than someone who doesn’t have anything on their record.  Therefore, if you have a DUI in your records it will most likely take you longer to get your ATT than your classmates who do not.
However, there is a chance that your state board of nursing will disqualify you from taking your boards.  You most likely will be required to submit additional paperwork to your board of nursing if you have a felony, misdemeanor, or criminal offense. Again, it’s a case by case kind of situation so there is not necessarily a clear cut answer since there are so many variables.  This is a great blog post which provides more detailed information.  This is another blog post with tips of writing a letter of explanation to your board of nursing regarding the DUI.

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NCLEX: transfer to a different state

Ok so answering this question will take some explaining, so bear with me.  You can take your NCLEX where ever you want.  What matters is where you want to practice.

 

I personally studied in Iowa, tested in Indiana, and practiced in Illinois.  

 

So, the NCLEX is the NCLEX. It’s written by the NCSBN and administered by Pearson Vue. That setup doesn’t change, no matter what state you’re in.  You take the test at a Pearson Vue testing center, and they send your results to whichever board of nursing you tell them to.  What does differ between individuals is which board of nursing you apply for your licensure. If you want to work in a state, you must apply to their board of nursing to work there.

 

If you have not taken the NCLEX yet, you would apply for “licensure by examination”.

 

If you have taken and passed the NCLEX already and been licensed by a state board of nursing but want to practice in a different state, you would apply for “licensure by endorsement”.  
To go back to my personal example, I graduated in Iowa.  I applied for my NCLEX like everyone does, no matter which state. I applied to the Illinois State Board of Nursing under “licensure by examination” and Pearson Vue simultaneously. Once I received my authorization to test (my ATT), I then selected my testing location on the Pearson Vue website. I lived near the Indiana border so the most convenient location was there.  I tested there, but was licensed by Illinois and practiced in Illinois.  

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NCLEX labs to know:

There are quite a few labs to know to be successful with the NCLEX. Please note that just because something is listed below doesn’t mean you will definitely see it on the exam.

 

Electrolytes: potassium, sodium, calcium, chloride, magnesium, phosphorus

 

Most common labs: RBC, HGB, HCT, PLT, WBC, PT, INR/PTT, Albumin, Creatinine, BUN, Glucose, HBGA1C, BNP, UA, Troponin I, Cholesterol, Ammonia, Total Bilirubin, Lactic Acid, ABG’s.

 

[vid url="https://youtu.be/EGyF57D7sus"]
We created an entire course which focuses solely on these labs. You can check it out here, or as part of our NRSNG Academy, along with ten other courses. !

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NCLEX drugs to know:

Please keep in mind that medications change… some get discontinued, and new ones are created. This list was compiled in 2016.  Also, it is impossible to predict the exact medications you will see on the NCLEX.  This is a list of the most commonly tested.  What is helpful to understanding these medications is also understanding their classification and mechanism of action. We created an entire course that discusses each of these meds in-depth, as well as classes of medications, skills videos, cheatsheets and downloads.  You can check it out here, and it also comes in our NRSNG Academy, along with ten other courses.

 

Here is the list of the most commonly tested meds, in alphabetical order by generic name*:

Acetaminophen, albuterol, alteplase, amitriptyline, amoxicillin, atenolol, atropine, bismuth subsalicylate, captopril, carbamazepine, carbidopa-levodopa, cefaclor, cefdinir, celecoxib, cephalexin, chlorpromazine, cimetidine, ciprofloxacin, clindamycin, codeine, cortisone, cyclosporine, clopidogrel, dexamethasone, diazepam, digoxin, diphenhydramine, diphenoxylate-atropine, divalproex, dobutamine, dopamine, enalapril, enoxaparin, epinephrine, epoetin, erythromycin, escitalopram, ferrous sulfate, fluoxetine, fluticasone, furosemide, gabapentin, gentamicin, glipizide, glucagon, guaifenesin, haloperidol, heparin, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, ibuprofen, indomethacin, insulin (novolog, novolin, humulin, lantus… basically all of the different kinds of insulin), iodine, isoniazid, ketorolac, lactulose, lamotrigine, levetiracetam, levofloxacin, levothyroxine, lisinopril, lithium, loperamide, lorazepam, losartan, magnesium sulfate, mannitol, meperidine, metformin, methadone, methylergonovine, methylphenidate, metoclopramide, methylprednisolone, metoprolol, metronidazole, midazolam, montelukast, morphine, nalbuphine, naproxen, nifedipine, nitroprusside, norepinephrine, olanzapine, omeprazole, ondansetron, oxycodone, oxytocin, pancrelipase, pantoprazole, paroxetine, phenazopyridine, phenytoin, procainamide, promethazine, propofol, propranolol, propylthiouracil, quetiapine, ranitidine, rifampin, rosuvastatin, salmeterol, sertraline, spironolactone, streptokinase, sublimaze, sucralfate, terbutaline, tetracycline, theophylline, trimethoprim-sulfamethoxazole, vancomycin, vasopressin, verapamil, warfarin
*The NCLEX will most likely provide the generic name rather than the trade name

RELATED PODCAST: MedMaster Show
RELATED RESOURCE: Nursing Pharmacology Guide

 

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NCLEX diets to know:

Advancement and consistencies

  • Advancing a diet: ice chips/sips of water, clear liquids, full liquids, soft/bland, regular (or whatever diet is appropriate for the patient)
  • Liquid consistencies: honey-thick, nectar-thick, thin (regular consistency)
  • Food consistencies: pureed, mechanical-soft, soft, regular

 

When you are concerned that a patient is not consuming enough to maintain appropriate nutrition

  • Consult dietitian (many nurses are able to do this under a screening protocol, while some many need a physician order… this depends on your particular facility’s policies and procedures)
  • Calorie counts
  • Consider nutritional supplements
  • Enteral or parenteral feedings may be necessary

 

Parenteral versus Enteral feedings

  • Parenteral: intravenously, called Total Parenteral Nutrition or TPN
  • Enteral: given down a feeding tube (nasogastric, Dobhoff, PEG), also called tube feedings (TF)
  • Oral food and hydration is always preferred, the next step would be enteral nutrition, and finally parenteral nutrition. It is always best for food to be administered and absorbed in the GI tract rather than intravenously, which is why they look to discontinue/wean TPN as soon as it is medically appropriate

 

Diets to know

  • Renal diets: quite restrictive…(protein, fluid, sodium potassium, phosphorus), but may be high in calorie
  • Alzheimer’s, bipolar (typically manic-state), or other mental-health diagnosis in which patients may go longer periods of time without remembering to eat: promote finger foods
  • Celiac disease / gluten-free: cannot have barley, rye, oats, wheat.  May not even be able to consume foods cooked on the same surfaces as these
  • Cardiac diets: fluid, salt, certain fat restrictions
    • Grapefruit juice is also contraindicated in many cardiac medications
  • Patients on Coumadin: restrict vitamin K
  • Gastric irritation (diarrhea, colitis, gastritis): low fiber, increase fluids, ensure appropriate electrolytes are consumed
  • Gallbladder issues: restrict fat
  • Pernicious anemia: increase foods with vitamin B12 (fish, shellfish, liver, beef)
  • Diabetic: conscientious of carbs and also may need to actually count the carbohydrates consumed to administer the appropriate amount of insulin

Consider pathologically what’s going on with the patient and then what would be best to ensure they are consuming what they need to maintain homeostasis.  For example, if you have someone who is nauseated and vomiting a lot, they most likely are going to have some electrolyte imbalances and dehydration… if someone has COPD and tires easily, we probably should provide higher-calorie foods in smaller but more frequent portion sizes so they don’t get too tired… if someone is constipated, we should look at foods with more fiber and increasing fluids.

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NCLEX Authorization to Test (ATT):

The NCLEX Authorization to Test or ATT is distributed by the state board of nursing to which you applied.  To be able to take the NCLEX, you have to apply to your state’s board of nursing to see if you’re eligible. They do a background check, review your records, and decide if they will let you sit to take the NCLEX in the first place.  (Concurrently, you’ll also register with Pearson Vue, the people who administer the test.)

 

Once your respective state board of nursing says, “Yea! It’s cool with us if you want to take your nursing boards!” they send you a form that basically communicates that information to the company who administers the test (Pearson Vue).  With your ATT, you’re able to schedule your test date with Pearson Vue.  You must have this to schedule a test date, or else Pearson Vue will not allow you to schedule.

 

ATT’s expire. So don’t get your ATT until you know you’ll want to schedule a test date, otherwise you may have to go through the entire process again.
Also, if you have anything on your records (a DUI, misdemeanor, felony, or anything), know that it may take you longer to receive yours than your classmates. It doesn’t necessarily mean you won’t get one. It just means they need more time to thoroughly review your records before authorizing you to take your NCLEX.

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Is There an NCLEX for multiple states

Where you take your NCLEX in the United States does not matter, geographically speaking.  You can test in Kansas but plan to work in Maine, but what matters is that you’ve applied to the correct state’s board of nursing. So if you want to work in Maine, you need to get registered and become eligible with the Maine Board of Nursing.  

 

However, there are 25 (and counting) states in something called the Nurse Licensure Compact. This is basically a multi-state nursing license.  This cuts down on paperwork, fees, and simply streamlines this whole process, which can be quite a headache.  If you get a license in one of these 25 states, you’re able to practice in the other states within the compact. You will have to be aware of and be held accountable to each respective state’s nurse practice act.  Keep in mind, this compact multi-state licensure does not apply to advanced practice nurses (NP, CRNA, etc.).  
For more information or to see if your state is included in the Nurse Licensure Compact, click here.

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NCLEX for Dummies

Passing the NCLEX will require planning, time, and effort – but it is totally doable and conquerable!  At NRSNG, our recipe for NCLEX success includes the following:

 

  • Being aware of how the NCLEX and NCLEX-style questions are structured
  • A general nursing knowledge base
  • Regularly taking practice questions
  • Taking a simulation of the NCLEX before the big day

 

We have created resources to address each of the following crucial aspects to NCLEX success:

 

Key to SuccessNRSNG Resource
Test taking knowledgeOur test taking course in the NRSNG Academy
Nursing knowledge baseThe entire NRSNG Academy
Practice questionsNCLEX Practice Questions, included in the NRSNG Academy
Simulation NCLEXSIMCLEX, included in the NRSNG Academy

And check out the NCLEX Test Plan Study Guide as well!!

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Taking the NCLEX a Second Time

So you found out you didn’t pass the NCLEX.  

 

First, it’s helpful to be aware of the retake policy of the NCSBN (the people who write the NCLEX). You’re allowed to take the exam again, but you must wait at least 45 days.  It would also be prudent to check your state board of nursing’s website for their policy on retakes.

 

Whenever you do not pass, you are mailed something called a Candidate Performance Report, or CPR. (I think they did that on purpose…)

 

They tell you how close you were to passing.  The more questions you got, the closer you were to passing (which may be quite different than it feels).  If you got fewer questions, you were farther away from the passing standard. Then, it goes into the specific sections of the exam and where you fell below the passing standard.  Here is an example CPR document from the NCSBN themselves.  

 

This document is crucial to passing the next time around. You must identify your areas of weakness in terms of knowledge so you know where to focus your efforts going forward.

 

Then, consider what other things may have impeded your ability to succeed.  

 

For example:

  • Did you have to drive 3 hours in traffic to the exam?
  • Did you have test anxiety?
  • Were you unfamiliar with the format?
  • Did you simply not know what to expect and had trouble calming down and focusing?
  • Are you just not a good test-taker?
  • Did you not do enough practice questions?
  • Did you wait too long, or tested too soon?
  • Were you not prepared for the alternate format questions?
  • Are you lacking in pharmacology knowledge?

 

After this, it is essential to come up with a plan to succeed.  Address any situational issues (like an ideal testing center location, being familiar with the format of the NCLEX, taking practice questions on a specific schedule, sticking to your study schedule) and then identify your knowledge gaps.  Then, attack!  Go get ‘em!  

 

And if you’re feeling discouraged, check out this podcast episode and summary blog post about Ashley, who failed the NCLEX three times and passed on her fourth attempt.
Remember, there are many amazing nurses who did not pass the NCLEX on their first attempt.  Patients don’t ask you how many times you took your board exams, they just want you to safely care for them.  While the NCLEX is the licensing exam, it does not define your career or you as a person, it is merely a step in your nursing journey.

RELATED POST: I Failed the NCLEX Three Times

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Is NCLEX a National Exam?

Yes, it is.  The NCLEX is written by the NCSBN and administered by Pearson Vue in the United States of America.  The content does not differ from state to state.  What differs from state to state in the process of obtaining your licenses in applying to your state board of nursing.

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NCLEX, a lot of SATA… what does that mean?

The NCLEX is a computer adaptive test (CAT).  You are first given a medium difficulty question, and if you answer it correctly… you’re given a more difficult question.  If you answer it incorrectly, you’re given easier questions until you answer one correctly, and then receive a more difficult question.  SATA (or select all that apply) questions are typically (however, not exclusively) more challenging.  Therefore, if you are continuing to get more challenging questions, that is a good sign.

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What are NCLEX Pass Rates?

According to the NCSBN, 84.57% of US educated individuals passed the NCLEX on the first try in 2016 (Source). However, this is the big-picture number. If you’re curious about your specific school’s pass rates, which is very important to know as you’re deciding which school to go to in the first place, there is a very easy way to find out!

 

Go to your state board of nursing website and look for NCLEX pass rates.  They should provide list of all nursing schools in that state and their pass rates.  

 

Let’s go through an example….

 

Let’s say I was thinking about going to a few different nursing schools in Iowa (University of Iowa, Mount Mercy, and Iowa Wesleyan) and I wanted to see their pass rates before I made my decision.  I would go to the Iowa Board of Nursing website and then click on Nursing Education Programs, and then Nursing Education Program Statistics, and then selected NCLEX Results By Program.  Then I was given a PDF of first-time pass rates for the NCLEX in the state of Iowa from 2012-2015.

 

Here is what I found about the three programs I mentioned above for 2015:

  • University of Iowa – 96% (out of 79 graduates)
  • Iowa Wesleyan – 100% (out of 16 graduates) – spoiler alert: I was one of them!
  • St. Ambrose – 76% (out of 51 graduates)

 

Ideally, you want to go to a school that will appropriately prepare you not only to pass this exam, but also to be a successful bedside nurse. You want to look at trends as well, because while Iowa Wesleyan had a 100% pass rate, their graduating class was a fraction of the size of the other two institutions.  If 1-3 people had not passed, that would have significantly altered the percentage.  
If you’re ever curious about the nation-wide NCLEX pass rates, just check out the National Council of State Boards of Nursing website (NCSBN), click on NCLEX, then Exam Statistics for the most up to date information.

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I need an NCLEX tutor!

Studying for the NCLEX can be pretty intense.  It’s not just simply recalling knowledge, you must be able to work through many kinds of questions, which are presented in various formats. You must have a content knowledge base as well be familiar with the style of questions.  We have created an entire Academy full of concise information designed to enhance your knowledge base as well as a test-taking course to help you destroy not only nursing school exams, but the NCLEX as well.  We have a SIMCLEX exam, which is designed to help simulate the NCLEX so you can get the feel for the style and environment as well as Nursing Practice Questions, which is a database of practice NCLEX questions.!

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I failed the NCLEX 3 times!

You are not alone!  There are many wonderful nurses who did not pass the NCLEX on their first… second… or even third try. It is possible to be a great nurse and have trouble passing boards.

 

I polled nurses on Twitter to see if a patient had ever asked them how many times they took boards.  I personally have never been asked, and these results didn’t surprise me at all!  Out of 713 people, only about 28 have ever had a patient ask about the amount of times they sat for the NCLEX.

 

However, you must take the time to really examine what happened with these attempts.  Check out the CPR (Comprehensive Performance Report) that is mailed to you which tells you what aspects of the exam you fell below the passing standard on. Process these experiences and your different approaches each time with a nurse who you know and trust and try to nail down some specific areas that you need to really focus on.  

 

Some people are great with the content, but it’s the test-taking aspect of things that really gets them.  Check out our wonderful test-taking course, which is part of our NRSNG Academy.
Also, check out this great interview with a nurse who also failed three times, but passed on her fourth attempt and is currently a registered nurse!

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I passed the NCLEX, now what?

The answer to this question really depends on what you’ve got going on. If you already have a job that you were accepted to on the contingency that you needed to pass the NCLEX, update your employer with your license number.  

 

Most likely, your paper copy of your license may be mailed to you by your state board of nursing sometime within the next few months.  

 

If you do not have a job already, start applying! Just make sure to keep note of your license number, as that will be asked on applications.

 

Update your resume to include your new licensure.

 

Don’t forget to add RN to your credentials behind your name!
And finally, see what your state requires in terms of renewal so you’re aware of the process when it’s required… typically in a few years.

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NCLEX: I ran out of time

Don’t start freaking out… yet! The NCLEX has a max time limit of 6 hours. Some people will run out of time when taking the exam.  However, just because you’ve run out of time does not mean you’ve failed. While there is a max time limit and max amount of questions, there isn’t a specific number of questions required outside of the minimum 75 questions. Remember, this is not like a typical nursing school exam. This is a computer adaptive exam.  

 

There is something from the company who writes the NCLEX (the NCSBN) called the “Run-out-of-time” (R.O.O.T) Rule.  Basically, if you run out of questions, they will evaluate your last 60 questions.  If at any point during the last 60 questions you fall below the passing standard, you will fail the NCLEX. If you stay above the passing standard for the last 60 questions, then you will pass the NCLEX. Remember – this doesn’t mean you answered all 60 correctly, it means that you stayed above the passing standard. So, maybe you answered a few extremely difficult questions incorrectly, but answered the others correctly… then you may have stayed above the passing standard in those last 60 questions and therefore passed.  
Here’s a great short video directly from the NCSBN that illustrates this rule well.

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Can anyone take the NCLEX exam?

No.  There are requirements to be able to sit for the NCLEX.

 

Your specific state board of nursing must deem you eligible to test, and these eligibility requirements vary from state to state.
A quick run-down of the process: first, you must apply to your state board of nursing.  While this process differs slightly from state to state, most state boards of nursing require the prospective nurse to submit their transcripts verifying they graduated from an approved nursing program (lists of approved programs are typically located on the state board of nursing website), complete fingerprinting and a background check, and only then can you cleared by Pearson Vue to test.

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Can I apply for the NCLEX before graduating?

The eligibility requirements to sit for the NCLEX vary from state to state and are dictated by that respective state’s board of nursing. However, most (if not all) states require prospective nurses looking to take the NCLEX submit transcripts which reflect that the candidate has successfully graduated from an approved nursing program. Some states will allow you to submit fees, fingerprinting and a background check before graduating to get the ball rolling, and then once you graduate you just send over your transcripts.  To find out definitively, take a look at your state board of nursing’s website.

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Can NCLEX Quick Results be wrong?

While there is the possibility of a computer glitch, that is very very very unlikely.  In most cases (and none of the nurses on staff have ever heard of it being wrong), the Quick Results is correct.  Because accuracy is essential, each exam is scored twice. Your Quick Results information is the computer scoring the test before it is double checked.  After it is double checked, your state board of nursing is notified of your results.  They will mail the official ones to you within approximately 6 weeks. Only after you receive official passing results can you begin practicing as a registered nurse

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Can the NCLEX be challenged? (I failed but I think I should have passed)

Challenging your NCLEX results would be something you would have to pursue through your respective state board of nursing.  Check out their website before trying to contact them however, because some states do not allow challenges. Many of those that do charge a hefty fee for a full review of every question, or charges per question to be reviewed.  Thankfully, because of extensive review of questions (written by currently practicing RN’s, went through a secondary review process, then in a pre-testing period before being allowed to be on the exam), having each and every NCLEX exam reviewed twice, and also administered on a computer, the likelihood of needing to challenge the exam is extremely low – if not next to none.

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Can the NCLEX be challenged? (I want to just take the NCLEX and not go to nursing school)

No. To be eligible to take the NCLEX exam, you must submit transcripts to your respective state board of nursing verifying that you graduated from an approved nursing program.

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Does the NCLEX allow calculators?

From the research we’ve done, it looks that there is a drop down calculator available on the computer that you can utilize whenever needed. However, we were not able to verify this with the NCSBN. You are not permitted to bring your own calculator.

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Does the NCLEX give both drug names?

Not every time.  In most cases, the NCLEX will provide the generic name.  This is done because there can be different brands and they want to make it very clear specifically what medication they are referencing. There are some instances in which a trade name may be provided, but for all intensive purposes assume that you will only be provided with the generic. They may also refer to the class of medications, rather than a specific med.

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Does the NCLEX vary by state?

No. It is a test written by the NCSBN, administered by Pearson Vue; both of which are national organizations. What differs between states is how you obtain your license.  This specific process is outline by your state board of nursing. Therefore, if you take the exam in California, Idaho, New Hampshire, or Michigan the content will be the same… but what will be different in each of these locations is how you get your license in your hand.

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How is the NCLEX broken down?

Below are the categories of NCLEX topics:

  • Physiological adaptation – 10%
  • Coordinated care – 21%
  • Safety and infection control – 13%
  • Health promotion and maintenance – 9%
  • Psychosocial integrity – 12%
  • Basic care and comfort – 10%
  • Pharmacological therapies – 13%
  • Reduction of risk potentials – 12%

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How to Study NCLEX Pharmacology

Pharmacology is such a huge NCLEX topic; it requires some strategy to study appropriately. It’s important to not merely study the name of drugs and dosages.  We recommend really understanding the medication classes as a whole, then diving into the specific drugs. This will enable you to understand their mechanism of action better, and therefore potential side effects, interactions, or issues.  Also taking some time to learn prefixes and suffixes will aid in memorization and association.  We actually created an entire course on pharmacology because we know it can be such a headache and challenge for nursing students.  It is part of our NRSNG Academy.  We go over 12 points to answering pharmacology questions, prefixes and suffixes, therapeutic drug levels, calculations, practice questions, the medication classes. 15 quizzes, 2 case studies and 16 cheatsheets/downloads.

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What are the NCLEX categories?

The NCLEX categories are as follows:

  • Physiological adaptation – 10%
  • Coordinated care – 21%
  • Safety and infection control – 13%
  • Health promotion and maintenance – 9%
  • Psychosocial integrity – 12%
  • Basic care and comfort – 10%
  • Pharmacological therapies – 13%
  • Reduction of risk potentials – 12%

 

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What to wear to the NCLEX?

Be comfy! You may be sitting in that testing center for as long as 6 hours, so it’s helpful to physically feel comfortable while taking this important exam. Keep in mind, they will make you remove any hats, scarves, gloves, and coats outside of the testing area. If you do have  religious headcover or attire, they do make exceptions.

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What’s the best NCLEX app?

Here is a comparison chart of some of the top NCLEX prep apps! It’s important to balance cost with number questions. I also highly recommend selecting an app that will provide rationales (why take the questions if you can’t know why the correct is correct?) as well as statistics on the questions (how hard is this question compared to others?).  All of the below provide rationales and stats.  We would not mention a company who does not.

 

AppPrice# of ?’s
NCLEX MasteryFREE – $24.991800 +
RN CrushFREE – $12.994000 +
Mosby’s NCLEX-RNFREE – $34.992800 +
Lippincott RNFREE – $49.994600 +

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Which is the best NCLEX review course?

The best nursing review course really depends on your educational needs.  Important questions to ask yourself when deciding:

  • How do I learn best? Audio, video, printed, in-person?
  • Do I want something I can utilize on mobile?
  • What can I afford?
  • Do I need test taking strategies in addition to content review?
  • Do I want access to practice questions? (Spoiler alert: YES)
  • Do I want to take a simulation NCLEX?

Here is a great list of various courses and reviews!  And here is a list of a few of the top options out there today.  Please keep in mind these prices and information was compiled in April 2017, this table may not reflect the most current prices, and these are all for NCLEX-RN programs.

 

CourseCostLearning format(s)Test takingPractice questionsSimulation NCLEXMobileRefund if you don’t pass?
Hurst$325-$425Options for in person, online webinar, printed materialYesYesYesNoYes
ATI$335-$500Online review and resources – unclear if you receive print versions from websiteAdditional course, costs $75YesNoNoNo; given additional 12 week access to their resources
NRSNG Academy$49.95/monthAudio files, image database videos, PDF’s to printYesYesYesYes200% refund
Kaplan$399-$499Options for in person, online webinar, printed materialYesYesYesNoYes

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What did you do the day before your NCLEX exam?

Cramming the day before the NCLEX is like running a marathon the day before you run a marathon. If you’re not ready the day before, you simply won’t be… and no amount of cramming is going to help.  Frantically studying as much as possible the day before will most likely do more harm than good, and increase your anxiety. Do something relaxing like get a massage, take a bath, binge watch you favorite show, take like 3 naps, go for a hike, lay on the beach… whatever may be relaxing for you.  Take some time to do that and give your mind a break, so you can come out of the gate swinging… ready to DESTROY the test.

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