Introduction

Introduction

English
Spanish

The NCLEX follows a variable question format. This means that the computer adapts the questions based on test takers’ performance. The NCLEX RN consists of 75-145 questions. This includes 15 pre-test questions that do not count toward test takers’ scores. The exam comes with a five-hour time limit. It’s important to note that you cannot skip questions and return to them. You have to answer a question to move on to the next one.

The test offers questions in different formats. (See Strategies for Success)

  1. Multiple choice
  2. Fill in the blank
  3. Ordered response
  4. Graphics questions

Test Plan Structure

The framework of Client Needs was selected for the examination because it provides a universal structure for defining entry-level nursing actions and competencies, and focuses on clients in all settings.

Client Needs

The content of the NCLEX RN Test Plan is organized into four major Client Needs categories. Two of the four categories are divided into subcategories:

Safe and Effective Care Environment
Management of Care
Safety and Infection Control

Health Promotion and Maintenance

Psychosocial Integrity

Physiological Integrity

Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation

Overview of Content

Safe and Effective Care Environment

The nurse promotes achievement of client outcomes by providing and directing nursing care that enhances the care delivery setting to protect clients and health care personnel.

Management of Care

The nurse provides and directs nursing care that enhances the care delivery setting to protect the client and health care personnel.

  • Integrate advanced directives into client plan of care
  • Assign and supervise care of client provided by others (e.g., LPN/VN, assistive personnel, other RN)
  • Organize workload to manage time effectively
  • Practice and advocate for cost-effective care
  • Initiate, evaluate, and update client plan of care
  • Provide education to clients and staff about client rights and responsibilities 
  • Advocate for client rights and needs
  • Collaborate with interprofessional team members when providing client care 
  • Manage conflict among clients and health care staff 
  • Maintain client confidentiality and privacy
  • Provide and receive hand off care (report) on assigned clients
  • Use approved abbreviations and standard terminology when documenting care
  • Perform procedures necessary to safely admit, transfer or discharge a client
  • Prioritize the delivery of client care
  • Recognize ethical dilemmas and take appropriate action
  • Practice in a manner consistent with a code of ethics for nurses
  • Verify the client receives appropriate education and consents for care and procedures
  • Receive and transcribe health care provider orders
  • Utilize resources to enhance client care (e.g., evidenced-based research, information technology, policies, and procedures)
  • Recognize limitations of self and others and utilize resources
  • Report client conditions as required by law (e.g., abuse/neglect, communicable disease)
  • Provide care within the legal scope of practice
  • Participate in performance improvement projects and quality improvement processes
  • Assess the need for referrals and obtain necessary orders

Related content includes, but is not limited to:

  • Advance Directives/Self-Determination/Life Planning
  • Advocacy
  • Assignment, Delegation, and Supervision
  • Case Management
  • Client Rights
  • Collaboration with Interdisciplinary Team
  • Concepts of Management
  • Confidentiality/Information Security
  • Continuity of Care
  • Establishing Priorities
  • Ethical Practice
  • Informed Consent
  • Information Technology
  • Legal Rights and Responsibilities
  • Performance Improvement (Quality Improvement)

Safety and Infection Control 

The nurse protects clients and health care personnel from health and environmental hazards.

  • Assess client for allergies and intervene as needed (e.g., food, latex, environmental allergies)
  • Protect client from injury (e.g., falls, electrical hazards)
  • Ensure proper identification of client when providing care
  • Verify appropriateness and accuracy of a treatment order
  • Participate in emergency response plans (e.g., internal/external disaster, bomb threat, community planning)
  • Use ergonomic principles when providing care (e.g., safe patient handling, proper lifting)
  • Follow procedures for handling biohazardous and hazardous materials
  • Educate client on safety issues
  • Acknowledge and document practice errors and near misses (e.g., incident report for medication error)
  • Report unsafe practice of health care personnel and intervene as appropriate (e.g., substance abuse, improper care, staffing practices)
  • Facilitate appropriate and safe use of equipment
  • Follow security plan and procedures (e.g., newborn nursery security, violence, controlled access)
  • Apply principles of infection control (e.g., hand hygiene, aseptic technique, isolation, sterile technique, universal/standard precautions)
  • Educate client and staff regarding infection control measures
  • Follow requirements for use of restraints

Related content includes, but is not limited to:

  • Accident/Error/Injury Prevention
  • Emergency Response Plan
  • Ergonomic Principles
  • Handling Hazardous and Infectious Materials
  • Home Safety
  • Reporting of Incident/Event/Irregular Occurrence/Variance
  • Safe Use of Equipment
  • Security Plan
  • Standard Precautions/Transmission-Based Precautions/Surgical Asepsis
  • Use of Restraints/Safety Devices

Health Promotion and Maintenance 

The nurse provides and directs nursing care of the client that incorporates knowledge of expected growth and development; prevention and early detection of health problems, and strategies to achieve optimal health.

  • Provide care and education for the newborn, infant, and toddler client from birth through 2 years
  • Provide care and education for the preschool, school age and adolescent client ages 3 through 17 years
  • Provide care and education for the adult client ages 18 through 64 years
  • Provide care and education for the adult client ages 65 years and over
  • Provide prenatal care and education
  • Provide care and education to an antepartum client or a client in labor
  • Provide postpartum care and education
  • Assess and educate clients about health risks based on family, population, and community characteristics
  • Assess client’s readiness to learn, learning preferences and barriers to learning
  • Plan or participate in community health education
  • Educate client about health promotion and maintenance recommendations (e.g., physician visits, immunizations)
  • Perform targeted screening assessments (e.g., vision, nutrition)
  • Educate client about prevention and treatment of high-risk health behaviors (e.g., smoking cessation, safe sexual practices, needle exchange)
  • Assess client ability to manage care in home environment and plan care accordingly
  • Perform comprehensive health assessments

Related content includes, but is not limited to:

  • Aging Process
  • Ante/Intra/Postpartum and Newborn Care
  • Developmental Stages and Transitions
  • Health Promotion/Disease Prevention
  • Health Screening
  • High-Risk Behaviors
  • Lifestyle Choices
  • Self-Care
  • Techniques of Physical Assessment

Psychosocial Integrity

The nurse provides and directs nursing care that promotes and supports the emotional, mental and social well-being of the client experiencing stressful events, as well as clients with acute or chronic mental illness.

  • Assess client for abuse or neglect and intervene as appropriate
  • Incorporate behavioral management techniques when caring for a client
  • Assess client’s ability to cope with life changes and provide support
  • Assess the potential for violence and use safety precautions
  • Incorporate client cultural practices and beliefs when planning and providing care
  • Provide end-of-life care and education to clients
  • Assess family dynamics to determine plan of care
  • Provide care for a client experiencing grief or loss
  • Provide care and education for acute and chronic psychosocial health issues (e.g., addictions/dependencies, depression, dementia, eating disorders)
  • Assess psychosocial, spiritual, or occupational factors affecting care and plan interventions
  • Provide care for a client experiencing visual, auditory, or cognitive distortions
  • Recognize nonverbal cues to physical or psychological stressors
  • Assess client for substance abuse, dependency, withdrawal, or toxicities and intervene as appropriate
  • Use therapeutic communication techniques
  • Promote a therapeutic environment

Related content includes, but is not limited to:

  • Abuse/Neglect
  • Behavioral Interventions
  • Coping Mechanisms
  • Crisis Intervention
  • Cultural Awareness/Cultural Influences on Health
  • End-of-Life Care
  • Family Dynamics
  • Grief and Loss
  • Mental Health Concepts
  • Religious and Spiritual Influences on Health
  • Sensory/Perceptual Alterations
  • Stress Management
  • Substance Use and Other Disorders and Dependencies
  • Support Systems
  • Therapeutic Communication
  • Therapeutic Environment

Physiological Integrity

The nurse promotes physical health and wellness by providing care and comfort, reducing client risk potential and managing health alterations.

Basic Care and Comfort

The nurse provides comfort and assistance in the performance of activities of daily living.

  • Assist client to compensate for a physical or sensory impairment (e.g., assistive devices,
  • positioning, compensatory techniques)
  • Assess and manage client with an alteration in elimination
  • Perform irrigation (e.g., of bladder, ear, eye)
  • Perform skin assessment or implement measures to maintain skin integrity and prevent skin breakdown
  • Apply, maintain or remove orthopedic devices
  • Implement measures to promote circulation (e.g., active or passive range of motion, positioning and mobilization)
  • Assess client for pain and intervene as appropriate
  • Recognize complementary therapies and identify potential contraindications
  • (e.g., aromatherapy, acupressure, supplements)
  • Provide non-pharmacological comfort measures
  • Monitor the client’s nutritional status
  • Provide client nutrition through tube feedings
  • Evaluate client intake and output and intervene as needed
  • Assess or intervene in client performance of activities of daily living
  • Perform postmortem care
  • Assess client sleep/rest pattern and intervene as needed

Related content includes, but is not limited to: 

  • Assistive Devices
  • Elimination
  • Mobility/Immobility
  • Non-Pharmacological Comfort Interventions
  • Nutrition and Oral Hydration
  • Personal Hygiene
  • Rest and Sleep

Pharmacological and Parenteral Therapies

The nurse provides care related to the administration of medications and parenteral therapies.

  • Administer blood products and evaluate client response 
  • Access central venous access devices 
  • Perform calculations needed for medication administration 
  • Evaluate client response to medication 
  • Educate client about medications 
  • Prepare and administer medications using rights of medication administration Review pertinent data before medication administration (e.g., contraindications, lab results, allergies, potential interactions) 
  • Participate in medication reconciliation process 
  • Titrate dosage of medication based on assessment and ordered parameters  
  • Handle and maintain medication in a safe and controlled environment 
  • Evaluate appropriateness and accuracy of medication order for client 
  • Handle or administer high-risk medications 
  • Monitor intravenous infusion and maintain site 
  • Administer medications for pain management 
  • Handle or administer controlled substances within regulatory guidelines  
  • Administer parenteral nutrition and evaluate client response

Related content includes, but is not limited to:

  • Adverse Effects/Contraindications/Side Effects/Interactions 
  • Blood and Blood Products
  • Central Venous Access Devices
  • Dosage Calculation
  • Expected Actions/Outcomes
  • Medication Administration
  • Parenteral/Intravenous Therapies
  • Pharmacological Pain Management 
  • Total Parenteral Nutrition (TPN)

Reduction of Risk Potential

The nurse reduces the likelihood that clients will develop complications or health issues related to existing conditions, treatments, or procedures.

  • Assess and respond to change or trends in client vital signs 
  • Perform diagnostic testing (e.g., electrocardiogram, oxygen saturation, glucose monitoring) 
  • Monitor the results of diagnostic testing and intervene as needed 
  • Obtain blood specimens (e.g., venipuncture, venous access device, central line) 
  • Obtain specimens besides blood for diagnostic testing (e.g., wound, stool, urine) 
  • Insert, maintain, or remove a nasal/oral gastrointestinal tube 
  • Insert, maintain, or remove a urinary catheter 
  • Insert, maintain, or remove a peripheral intravenous line 
  • Maintain percutaneous feeding tube 
  • Apply or maintain devices used to promote venous return (e.g., anti-embolic stockings, sequential compression devices) 
  • Use precautions to prevent injury or complications associated with a procedure or diagnosis 
  • Evaluate responses to procedures and treatments 
  • Recognize trends and changes in client condition and intervene as needed Perform focused assessments 
  • Educate client about treatments and procedures 
  • Provide preoperative or postoperative education 
  • Provide preoperative care 
  • Manage client during a procedure with moderate sedation 
  • Manage client following a procedure with moderate sedation 

Related content includes, but is not limited to:

  • Changes/Abnormalities in Vital Signs
  • Diagnostic Tests
  • Laboratory Values
  • Potential for Alterations in Body Systems
  • Potential for Complications of Diagnostic Tests/Treatments/Procedures
  • Potential for Complications from Surgical Procedures and Health Alterations
  • System-Specific Assessments
  • Therapeutic Procedures

Physiological Adaptation

  • Assist with invasive procedures (e.g., central line, thoracentesis, bronchoscopy) 
  • Implement and monitor phototherapy 
  • Maintain optimal temperature of client 
  • Monitor and care for clients on a ventilator 
  • Monitor and maintain devices and equipment used for drainage (e.g., surgical wound drains, chest tube suction, negative pressure wound therapy) 
  • Perform and manage care of client receiving peritoneal dialysis
  • Perform suctioning 
  • Perform wound care or dressing change 
  • Provide ostomy care or education (e.g., tracheal, enteral) 
  • Provide pulmonary hygiene (e.g., chest physiotherapy, incentive spirometry)
  • Provide postoperative care 
  • Manage the care of the client with a fluid and electrolyte imbalance 
  • Monitor and maintain arterial lines 
  • Manage the care of a client with a pacing device 
  • Manage the care of a client on telemetry 
  • Manage the care of a client receiving hemodialysis or continuous renal replacement therapy 
  • Manage the care of a client with alteration in hemodynamics, tissue perfusion or hemostasis 
  • Educate client regarding an acute or chronic condition 
  • Manage the care of a client with impaired ventilation/oxygenation 
  • Evaluate the effectiveness of the treatment plan for a client with an acute or chronic diagnosis 
  • Perform emergency care procedures 
  • Identify pathophysiology related to an acute or chronic condition 
  • Recognize signs and symptoms of client complications and intervene 

Related content includes, but is not limited to:

  • Alterations in Body Systems
  • Fluid and Electrolyte Imbalances
  • Hemodynamics
  • Illness Management
  • Medical Emergencies
  • Pathophysiology
  • Unexpected Response to Therapies

Remember

Pretest Items for computer-adaptive test CAT to function properly, the difficulty of each item must be known in advance. The degree of difficulty is determined by administering the items as pretest items to a large sample of NCLEX candidates. Since the difficulty of pretest items are unknown in advance, these items are not included when estimating the candidate’s ability and subsequently making pass-fail decisions. When enough responses are collected, the pretest items are statistically analyzed and calibrated. If the pretest items meet the NCLEX statistical standards, they can be administered on future examinations as operational items. There are 15 pretest items on every NCLEX-RN. Pretest items appear identical to operational items, and therefore it is recommended that candidates give their best effort for every item.

NCLEX Candidate Tutorial

The NCLEX Candidate Tutorial is provided to help candidates become familiar with the Pearson VUE exam software.

Start Tutorial