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. It’s not divided into pharmacology, pediatrics, and management like nursing school courses and tests. It is a comprehensive evaluation of the nursing graduate’s 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 you’re 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.
Practice means answering the questions and remediating them to understand what they do and don’t 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 ncsbn.org 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.
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 ncsbn.org 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, that’s around 50 questions. For others, it’s 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: it’s 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 (I’ve had several students who swear by peppermint); and the most crucial technique to combat anxiety, is tip #4–show up prepared.
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 ncsbn.org 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 Nursing, 9, 125-136. doi: 10.4236/ojn.2019.92012.
The National Council Licensure Examination is a prerequisite for becoming a nurse, and with increased nursing school applicants, we thought it would be worthwhile to offer tips on how best to pass the NCLEX. We each tried our techniques and utilized similar options to help us pass the exam in May of this year. With some guidance from our parents, we also have plenty of tips to help others pass this challenging exam with much more confidence than you otherwise might have exhibited.
Watch Tips and Tutorials on YouTube
YouTube has tons of great material on every subject, including the NCLEX. We recommend finding some tutorials and tips to help you pass. Shannon, in particular, used this study method for subjects she didn’t fully understand. It enables you to gain knowledge in areas where you’re lacking and is just a fun, easy way to gain more information and help you feel more confident with that material.
Allot Yourself So Many NCLEX Questions Per Day
Don’t try to push yourself to get through hundreds of practice questions when you don’t have the mental capacity. Instead, give yourself a few months to take your time and practice until you feel comfortable. It’s best to allot yourself so many questions daily and only focus on getting through one set at a time. Shannon stuck with the 75 questions per day rule, and it helped.
You can also go with Kristyn’s technique and allot yourself so many daily topics. Then, pick two or three and work on the material until you feel like you’ve nailed it. She spent one month working this way until she felt confident she could pass the test.
Study and Correct Your Incorrect Answers
By only focusing on so many questions each day, you have time to go back over the answers. You can correct anything you got wrong and take the time to understand why it was wrong. Then, use your results to help you study better and refocus on the problems you’re having trouble tackling.
Let Your Family Help
You don’t have to do this alone. Sure, you’ll be the only one taking the test, but that doesn’t mean you can’t get help practicing and preparing in the meantime. Let your family help you in any way they can—we both did. Kristyn’s mom helped her by being a pretend patient. Her aunt and uncle let her stay with them while in college to help save on costs. Shannon’s dad tried to help keep their dog occupied, so he wasn’t in her way or disturbing her studies.
Be Sure to Eat Healthily
Speaking of Shannon’s dad, Mark stresses the importance of eating well. It’s important to eat something healthy and keep your body full and your brain working to the best of its ability while studying and before you have a big exam. So, eat something healthy and keep your body full and your brain working to the best of its ability. That will go a long way toward ensuring you can pass your NCLEX without the pangs of hunger interrupting your thought process.
Also, Enjoy a Snack
You don’t have to eat all the time healthily, however. Sometimes, it’s good to get your favorite snack and reward yourself a little for the hard work you’ve been doing. So, grab your favorite candy bar and savor every bite before you get back to the work at hand. That little bit of goodness in your day can be a huge motivator and help when feeling down.
Add Vitamin D to Your Day
It’s also essential to make sure you’re staying healthy overall. Adding Vitamin D to your day, especially by soaking it up outside, is beneficial for how you feel mentally. Don’t just sit and study for the entire day. Get outside. Enjoy the fresh air. Take the break you need and deserve. It will help give you mental clarity so you can return to your study routine afterward.
One of the best things you can do for yourself (or a family member) is to purchase a pretest system that allows you to see how well you would do on your NCLEX. It’s excellent practice and shows you the areas where you need additional guidance before you take the actual test. We used UWorld, and it offers options for both RNs and PNs. It helped us gain the information and experience necessary to help us feel genuinely prepared for the exam in real life. In addition, the UWorld NCLEX-RNⓇ provides more than 2,000 questions to help prepare for your impending. If you want easy-to-understand information, this program is for you.
Take Your Time During the NCLEX
Our final piece of advice is to take your time. It isn’t necessary to feel rushed during the NCLEX because you get five total hours for the entirety of it. Don’t rush through any questions. Please read it thoroughly so that you’re entirely comprehending what it’s asking. Some questions can be tricky, and you’ll misinterpret what it’s asking for if you don’t read them all the way through and give yourself time to sort through the possible answers.
Why Preparing to Be a Nurse Is So Important
It takes a village to support nursing students and current nurses, particularly given the added stress of the pandemic. In addition, as current nurses are exiting the profession due to burnout or attrition in large numbers, student nurses must find the resources they need to support their academic and career goals. A family and friends support network can also help make all the difference in reaching your goal of being a nurse with a healthy work-life balance.
This article written by Shannon Rosen and Kristyn Smith was published in the September 2022 issue of Minority Nurse.
About the authors
Shannon Rosen graduated from Nova Southeastern University, passed the NCLEX in May 2022, and is an Operating Room Nurse at Naples Community Hospital in Naples, Florida.
Kristyn Smith graduated from Chamberlain University, passed the NCLEX in May 2022, and is a Pediatric ER Nurse at a hospital in Houston, Texas.
Approximately 85.11% of candidates passed the NCLEX RN on their first attempt in 2017, according to the National Council of State Boards of Nursing (NCSBN). You can be one of those who passes the exam on the first try, too; you just have to know how and work through it.
Here are five tips to help guide you.
1. Familiarize yourself with the NCSBN website.
The NCSBN website provides critical information that you need to know about the NCLEX before taking the exam. Check all the rules and requirements. You need to get to know anything and everything you can about the exam so you can take the NCLEX exam with confidence.
2. Start preparing early.
Give yourself enough time to study. Establishing a timetable for your study is essential. Manage your study as if it is your full-time job. Try and get rid of all distractions, and make sure you feel as comfortable and able to focus as possible. Everyone is different, so make sure you develop a study routine that works for you, whether that’s studying in the AM if you’re a morning person OR in the evening if you are most productive at night.
3. Discover your knowledge early on.
It is crucial that you figure out the areas where you feel especially weak and that you need to focus on the most. Make sure that you spend more time reviewing content material related to these areas and keep practicing.
4. Take practice exams every day.
One of the most effective ways to prepare for the NCLEX exam is to practice taking past versions. It is important to take multiple practice tests and answer hundreds of questions in order to become increasingly familiar with the test format and questions. Also, take more time to review the correct answers for the questions you got wrong. The NCLEX exam is designed to determine if you have nursing knowledge and critical thinking skills required to begin practicing as a nurse. You are required to analyze the test questions using your critical thinking skills and nursing knowledge to make decisions about common nursing situations. There are a great deal of online guides and test questions, many of them free or at an affordable price. Make sure that you take advantage of these resources. A particular resource that I would recommend is the NCSBN’s Review for the NCLEX Exam.
5. Last but not least, set yourself up for success on the test day.
Stay positive and expect to pass. What everyone says is true–a good night’s sleep can make all the difference. Make sure you go to bed early the night before the test and regulate a full night of sleep (at least 7-8 hours). Be relaxed during the exam and remind yourself that you are well-prepared for the exam and ready to pass.
For nursing students there is one final hurdle after graduation to becoming a nurse – passing the NCLEX. The National Council Licensure Examination is the standard state exam that all graduating nurses must pass in order to start their career as an entry-level nurse.
It can be a stress-inducing time for a young nurse. But there are some things you can do while you’re still in nursing school to lessen the stress on exam day.
Follow these tips to prepare for test day.
1. Study All Through School
First and foremost, don’t wait to begin studying. Use your time throughout nursing school to prepare. “NCLEX tests safety competency and is not a test you can cram knowledge in a short period of time,” says Dr. Joanna Rowe, interim dean of nursing at Linfield College in McMinnville, OR.
Dr. Rowe says there are several study programs available including Kaplan, HESI, and ATI.
Another resource Dr. Rowe recommends is a PassPoint, which can be purchased for $100 for use on your phone or computer. “Students can design their own tests and they can select areas for the program to generate a test. Also, the National State Board of Nursing has an NCLEX study plan they can download that is very inexpensive.”
Dr. Rowe advises students to take practice tests in an environment similar to the one you’ll take the real NCLEX. That means no music, headphones, noise, or anything to drink or eat. Take your practice tests in a quiet, uncluttered space and take the whole practice test in one sitting.
3. Take Time to Review
“Review each question on the practice test even if you got it correct. Look at why you got it correct,” says Dr. Rowe. “Did you know the answer or guess at the answer and does your rationale match the rationale offered? If you got it wrong, why did you get it wrong? Did you not know the answer, read too fast, misread the question, knew parts of the answer but not in depth?”
Taking the time to review after your practice tests will offer key insights that will help you ultimately pass the NCLEX.
4. Take the NCLEX Right After Graduation
Finally, Dr. Rowe advises students to take the NCLEX within six weeks of graduating from nursing school. “The statistics are clear that students who take NCLEX within the first six weeks of graduation have a significantly higher pass rate,” says Dr. Rowe.
Often it’s not nursing knowledge that makes the difference in passing nursing boards, but having strategies for answering questions so that it’s apparent that you really “get it.” There are ways to prepare for what is often a daunting test so you can take it with complete confidence that all the time, money, and hard work that went into nursing school won’t go to waste. We interviewed experts, educators, and other nurses who aced these exams—first time around or later—and share their most helpful hints with you here.
Jake Schubert, RN, BSN Travel nurse and executive director of Nursity.com, an online NCLEX strategies and review course
1. Carefully consider your options.
“The average candidate takes one or two prep or review course, and spends an additional 40 to 50 hours on other independent study,” according to Schubert. He recommends that students talk to their peers about their experiences and read online testimonials. In addition, check to see if your school has partnered with a test-preparation program. “Some schools provide review courses as part of the capstone curricula—ATI, Kaplan, and HESI are the big corporations with relationships with many of the schools. Most students take an additional course as well,” he adds.
2. Understand the NCLEX format and how it works.
“When you intimately know the beast, it won’t be as intimidating,” says Schubert. Because this is a computer adaptive test that uses algorithms, it’s different from every other test students have taken in their entire academic career. You must also prepare for it differently. “If you did exceptionally well or performed extremely poorly, the exam will end at 75 questions,” he explains. But if you are somewhere in the middle, it can go up to 265 questions to assess how well you know the material and whether you’ll be able to perform as a nurse in a safe manner. (See Schubert’s YouTube video—“How to Pass the NCLEX with a 58%” for more details about this type of test.)
3. Strategize how you will approach questions in which you don’t know the answer.
Most students who graduate from nursing school have sufficient content knowledge, but because the test is computer adaptive it will find an area where you are weak, says Schubert. “The NCLEX will assess your judgment as much as anything else.” What will you do when you don’t know what to do? You need strategies for these types of questions. “How do you answer a question about content you never learned? Strategy. Ask yourself, ‘Why did they write this question? Is it a medication question? A judgment question?’ As a new graduate nurse, that’s all you do all day, is try to figure out what to do in situations you don’t necessarily fully understand. This is much of what the NCLEX is assessing—will you make a safe decision?” he adds.
4. Don’t wait to study or take the exam.
The longer you wait, the more you forget, and the worst you score. “Take the exam immediately after graduating from nursing school,” Schubert advises. “Begin studying for the NCLEX before you graduate, to keep the material fresh in your mind, which will improve your score. Pass rates go down the longer a candidate waits after graduation,” he says. To find out more about pass rates, we recommend you go directly to the source: the National Council of State Boards of Nursing website at www.ncsbn.org.
5. Figure out the best way for you to study, and then stick with your plan.
“Keeping to a study schedule and certain days and times is important,” says Schubert. “But don’t cram. Instead, spread it out over a longer period.” He also recommends reducing distractions, such as television, devices, and social media as well as calls or visits from family and friends. Make sure your study area and equipment are well set up so that you’re comfortable during each study session. Then take frequent breaks so that you don’t deplete your energy, and switch among various subjects every half hour or so to maintain focus.
Launette Woolforde, EdD, DNP, RN-BC Vice president of system nursing education at Northwell Health in New Hyde Park, New York
1. Find a role model with a similar background.
“When you don’t have minority role models that reflect who you are, it can hamper your optimism and pursuit of certain goals,” says Woolforde. “For example, I remember reading that 12% of the U.S. population is African American, but only 2% of nurses in the workforce are African American.” The lack of role models may extend to educators, staff, and mentors who can help monitor and guide students. On the other hand, those missing pieces of the career puzzle “can serve to motivate students to start a new trend and make a clean break from what’s happened before,” she adds.
2. Be aware that factors such as language, cultural norms, and your environment can influence your standardized testing experience.
Being a first-generation nurse or college student, for example, means you have to figure out your own way around in academia and career preparation, says Woolforde. “Minority nurses might not fit the norm in their family or culture. But I’m happy to see so many nurses exceeding these norms. Soon, minorities will be the majority in the U.S.”
Minority test-takers may have to “think against” their own cultural norms, cautions Woolforde. “Maybe in your culture women do not make decisions. You have a question about a patient coming into the ER—a male with a wife—and the wife is upset and vocal about it. How would you answer the question? The correct response is ‘Reassure the wife,’ but what if in your culture, wives aren’t spoken to? A wife may be dismissed in that culture.”
3. Do two or three things to “pump yourself up” each day.
“Overthinking and overprocessing while studying is a problem,” says Woolforde. “Don’t try to master everything. Do a little bit every day. Take tests over and over. Spend more time doing practice tests than in reviewing your general knowledge.” Some review services provide assessments, so take a look at your pharmacology scores, for instance, and decide if you need to allocate more time to that section of the test. Nursing students know a lot, but when they look at the questions they may not understand what the question is really asking. “It’s not ‘What is this medication for?’ but more about ‘What would you do to prepare a patient?’ For example, if a patient is taking Lasix then he needs a diet that’s rich in potassium,” she says. “Review what you’ve learned over the years. Believe in yourself. You’ve come this far, so you can pass this exam. There’s great positivity that comes from that belief. There’s power there.”
4. Don’t let fear hold you back.
Fear of failure and fear of the unknown are two major hurdles for many minority nursing students, says Woolforde. “They ask, ‘Am I smart enough?’ They’re afraid that they’ll fail the test because they don’t know the right answers. They’re afraid there’s material that they didn’t get in school or that they didn’t study it enough. I usually tell them all that might be true—you might not know the answer outright. But you can usually rule out two answers and reduce your choices. Then reread the question, think about it, and let the right answer surface,” she advises.
5. Think beyond the NCLEX.
“Even during your orientation, you can be thinking about specialty certification,” says Woolforde. “If you work in oncology and pediatrics but like peds, then you may decide, ‘This is where I want to spend my career.’” Next, consider specialty board certification as a stamp of expertise in an area of practice. In order to maintain that certification, you have to maintain a minimum number of continuing education hours and must practice for a minimum number of hours there. “Certification shows that you’re current with best practices; you’re currently practicing and staying on top of trends and issues in that specialty,” she adds.
G. Rumay Alexander, EdD, RN, FAAN Interim chief diversity officer and director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill
1. Keep your mind in the game.
For highly vulnerable students, every test becomes a test of language proficiency, says Alexander. Multiple choice questions are especially problematic, she adds, so practice to understand how they’re structured and how to answer them. “Outside of the U.S., most countries don’t use multiple choice questions on tests, so international students may need more help to pass. Non-English speakers typically need to translate questions into their own language and then retranslate their answer in English. Older students are another minority group that is disadvantaged; they’re out of practice with test-taking.”
2. Understand that half the battle is staying level-headed.
“Try not to let your brain get hijacked by emotions,” advises Alexander. “Avoid being hungry, angry, lonely, or tired [“H.A.L.T.” is a good memory aid]. Make sure you’re well-nourished, well-rested, and really and truly try not to get panicked because you don’t know the answer immediately. Answer the questions you are certain you know and then revisit the questions you skipped.” It’s normal for people taking the NCLEX to think that they’re failing, so try not to be overwhelmed if you need to skip questions. Usually, you are doing fine, so just stay the course.
3. Tap the various staff members and other resources that your school provides.
“We have student advisors who meet with students and take them through different tests and practice exams,” says Alexander. Practice questions come from the end of textbooks, or students go online and get questions that best address their weak spots. “Students who have test anxiety can get help at a center that helps with managing anxiety and practice with testing, too,” she adds.
4. Find your happy place.
When highly vulnerable students were not passing gatekeeper exams at her school, Alexander asked the school’s “cultural coaches” to work with them. “We told the distressed group to forget about the exam and we asked them this question: ‘If you didn’t have that coming up, what would you do?’ Their response was ‘Let’s have a party!’ so we blasted music for 40 minutes and they taught each other new dances. There was laughter, joy, and smiles. Then they went on to study for the exam.” The nursing students were advised to do visualization exercises for stress reduction, like the school’s winning basketball team did before a game. “We told them, ‘When you’re stuck on a question during the exam, go back to this time. Remember the dance or anything that makes you feel peace, joy, or sense of accomplishment.’” The visualizations worked, and students later reported that their anxiety was greatly reduced when they applied the technique.
5. Understand that not everyone will pass the exam on the first try—and that’s OK.
“If you failed, well, you’re not the first person who has,” says Alexander. “Maybe you need to practice more or review a certain part again. Students repeat exams all the time. It’s not a denial of your dream; it’s a delay. Maybe you need to work more on test anxiety or preparation. Failing should inform you, not defeat you.”
Sometimes students face difficulties right before the exam that throw them off course, such as a suddenly ill child or a minor fender bender. Everybody has a bad day, Alexander explains, and the main thing is to resist the urge to ruminate. “Instead, focus on what’s next,” she suggests. “Ask yourself, ‘What do I want? What’s my next move?’ Remember, there is a skill to test-taking and it takes intentional preparation. Prepare, don’t despair!”
There are so many ways to prepare for the nursing boards now, what with new technology as well as in real-life social support. You can pick and choose the techniques that work best for you. Take an online review course, use an app, study with a group, or set up an at-home program. Success is absolutely within your reach!