May signifies everything we look forward to–time for graduations, pinning ceremonies, vacations, and anticipation for warmer weather; however, for the recent nursing graduate, May also signifies a time for preparation for one of the most important exams they may ever take, NCLEX. Graduates can look forward to taking the NCLEX if they remember PUPS. (More on PUPS below).

As nurse educators, we know that prepping for NCLEX differs from preparing for a classroom exam. For one, the NCLEX is a cumulative exam that focuses on one thing, clinical judgment. Can the student make the best decision for their patient at the bedside?

Secondly, the NCLEX tests integrate processes like safety, infection control, and physiological integrity throughout the test. Its not divided into pharmacology, pediatrics, and management like nursing school courses and tests. It is a comprehensive evaluation of the nursing graduates ability to holistically care for a patient, from basic care and comfort to management of other healthcare staff.

Because of this comprehensive and integrated approach, questions may look different and be perceived as more difficult. Medications and disease processes the student did not learn in class may be tested. For most students, the unknown is a scary concept. However, there are things we can do, even last minute, to prepare our students.

Remember PUPS. If youre like most nurses, we care for humans and animals. Hopefully, PUPS is an easy to remember mnemonic and one with a positive connotation.

Practice NCLEX-style questions

Understand the NCLEX

Practice anti-anxiety techniques

Show up prepared

Practice NCLEX- style Questions

There are studies and literature that state a student must answer 5000 to 10,000 questions to be deemed ready for NCLEX. There are hundreds of websites that students frequent that provide many different numbers. I have seen very specific numbers, from 2800 questions to as low as 500. Quantity matters, but quality matters more.

We must inform our students that practicing NCLEX-like questions is critical to success and where they can find those questions. Please provide them with the names of credible resources and encourage them to practice as many questions as possible.

See also
Thank a Nurse with RNspire

Practice means answering the questions and remediating them to understand what they do and dont know. Practice does not mean answering question after question but never reviewing the answers and rationales. The question banks students use for preparation should include an opportunity for testing in an NCLEX-like environment and provide a review of answers with rationales. The practice question banks should also have alternate-type questions on NCLEX and be written at the cognitive levels of application and analysis.

Practice means simulating the real testing environment by sitting in a quiet room and answering the questions on the computer while you time yourself. The NCLEX today is 75-145 questions with a five-hour allotment. Encourage your students to take a 75-question minimum test and to take several 145-question tests as well. Practicing a few questions at a time is okay but should be only some of the practice. 

Endurance is important. Most students graduate from nursing school and have never taken more than 100 questions at one time. However, they must practice a 145-question test and note when they get tired or lose concentration to take a break in the real” test. Therefore, a student should never sit for NCLEX without having the benefit of practicing 145-question tests. 

Understand the NCLEX

All students taking the NCLEX should have visited the website many times. They should know the NCLEX blueprint–the definitions of the client need categories tested and at what percentage they are tested. Students want to know what is on the test to feel more comfortable and confident. The NCSBN gives them that information. Maybe not to the specificity the student wants, but it provides much beneficial information, and knowledge is power.

See also
Cultivating a Culture of Success in an Undergraduate Nursing Program: Meeting Students Where They Are

For example, a student must know that physiological adaptation, management of care, and pharmacological and parenteral therapies make up almost 50% of the NCLEX-RN. Therefore, these three areas command more attention than the other five areas of the test plan.  

Students should also watch the videos on the website that explain the testing procedures for check-in and while taking the test. These videos include what you can and cannot bring with you, allowable breaks, accommodation requests, and much more. Knowing what to expect lessens anxiety.

Practice Anti-anxiety Techniques

As mentioned above, one of the reasons students practice questions is to understand their mental and physical endurance. Students should note when they get tired or lose focus while taking a long exam. For some students, thats around 50 questions. For others, its about ten questions. Students need to know this before sitting for NCLEX. When they reach their limit, instruct them to take a mental break. That could mean taking fingers off the keyboard and eyes off the screen, completing a few stretches of the shoulders and neck, or taking a few deep breaths.

A quick note about deep breathing: its not just something to do. Deep breathing better oxygenates your brain, stimulating the parasympathetic nervous system, which aids in calmness. Deep breathing is an important anti-anxiety strategy for us all. 

Other techniques to combat anxiety include getting adequate sleep (which is especially important the night before the test); eating a good meal before the test so that you are not hungry (do not overdo it on carbs or sugar, which can cause sleepiness); proper hydration preferably with water and a bathroom break before the exam; positive talk before and during the exam (You got this!); eating peppermint candy or chewing peppermint gum which can decrease anxiety and possibly increase mental alertness (Ive had several students who swear by peppermint); and the most crucial technique to combat anxiety, is tip #4–show up prepared.

See also
Developing Chapter Champions

Show Up Prepared 

There is no better technique for success than attending an exam and feeling well-prepared. Know where the testing center is and leave early to give yourself plenty of time for unexpected traffic. Students should double-check with that they have the correct documents to get into the test.

At this point in their preparation, they know the content, the process, and what to expect. There are no surprises because they have used PUPS – practiced thousands of questions, understand how the test works and what is being tested, know how to calm anxiety because they have practiced calming techniques, and are showing up prepared and confident.



Hanson-Zalot, M. , Gerolamo, A. and Ward, J. (2019) The Voices of Graduates: Informing Faculty Practices to Establish Best Practices for Readying NCLEX-RN Applicants. Open Journal of Nursing9, 125-136. doi: 10.4236/ojn.2019.92012.

Maria Flores-Harris
Latest posts by Maria Flores-Harris (see all)
Share This