38.2 NCLEX Preparation

Assessment of Nursing Knowledge by the NCLEX-RN

The NCLEX-RN changed in 2023 due to research evidence of the need for nursing graduates to show increased understanding of safe practice at the entry level. The focus and formatting of the questions on the licensure examination changed to meet this goal. The examination now presents the test-taker with items (questions) that pose problem-solving scenarios, in short form as specific questions, or in longer form as client need categories. Candidates can expect items to address categories as depicted in Figure 38.2.

Figure 38.2 This graph shows the approximate breakdown in categories of questions on the NCLEX, but distributions may vary slightly based on individual examinations. (modification of work from Psychiatric-Mental Health Nursing. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

To guide the candidate’s study, meaning of the categories depicted left-to-right on the graph are as follows:

• Management of care means the nurse observes scope of practice guidelines, incorporates all available support, delegates and directs others, and conserves resources.
• Pharmacological and parenteral therapies mean the nurse safely administers or supervises safe administration of prescribed medications, fluids, and blood products by all routes and teaches and monitors indication, intended effect, side effects, and adverse reactions.
• Physiologic adaptation means the nurse manages and promotes patients’ adjustment to emergency, corrective, or supportive care, interventions, and treatments.
• Reduction of risk potential means the nurse monitors for complications of patients’ diagnoses and educates and intervenes to mitigate potential harms and adverse outcomes to care and treatment.
• Safety and infection control means the nurse recognizes and mitigates harm and risks, observes practice standards, monitors patient acuity, and educates others.
• Health promotion and maintenance means the nurse brings preventative care and wellness care at all stages of human development, detects potential problems, and conducts health screening.
• Psychosocial integrity means the nurse promotes patients’ adaptation and stress management, teaches others, integrates nursing interventions, advocates for emotional, social, and spiritual wellness, and delivers psychiatric nursing care in therapeutic settings.
• Basic care and comfort mean the nurse provides and directs physical care for basic needs, such as nutrition, hydration, comfort, elimination, activity, and rest.

The essence of nursing practice is the identification of client needs, which are then addressed through the nursing process. By successful completion of the NCLEX-RN, nursing graduates show their competence at the entry level of practice.

Computerized Interactive Questions

The NCLEX-RN items measure clinical judgment by NGN (or Next Generation NCLEX) case study and stand-alone questions. Case studies present multiple questions about a realistic nursing care scenario. Stand-alone items ask for application of the six elements in Layer 3 of the CJMM, which are steps of the nursing process, and, as discussed in previous chapters, depict the actions the nurse can take. Answers may be entered by “click to specify” or “click to highlight” chosen responses. Test item formats include bow-tie, drag-and-drop, drop-down, extended multiple response, and matrix. Visualizing questions on a split screen is another new feature of the exam.

• Bow-tie: Move provided answers to provided categories.
• Drag-and-drop: Move provided answers to the correct target.
• Drop-down: Select an option from text, chart, or table.
• Extended multiple response: Select all applicable responses; partial credit is awarded for items with more than one key.
• Matrix: Select from a table of options in columns or rows.

Available Resources

Knowledge base and examination preparation together are essential for NCLEX success.

Schools of nursing provide preparation for the NCLEX throughout the nursing program, many utilizing a software package (e.g., Kaplan, ATI). Near graduation, programs offer more specific preparation in the forms of exit exams, capstone projects, clinical preceptorship/field placements, or wrap-up components of the school’s software product. In addition, final semester students frequently present a project that is designed to bring together multiple concepts of nursing practice.

There are numerous NCLEX preparation offerings. Nursing graduates may personally decide how to customize the process. What is important to the test-taker? Graduates should consider their own learning style. Printed materials, online formats, mobile applications, videos on demand, practice questions, recorded mini-lectures, question libraries, and real-time study groups, coaches, and tutors are all available.

Graduates may want to consider whether the study resource contains access to customized study help and access to user reviews. Cost is another factor, whether purchase or subscription. The testing programs selected by the graduate’s school of nursing can serve as a guide for NCLEX prep or prompt investigation into what other schools use. Important to consider is practice with simulated adaptive NCLEX-style test items. The graduate’s selection of preparation packages should include those that provide a focus on Next Gen-type questions.

Application of Clinical Judgment to Patient Care

Nursing graduates can think of the NCLEX-RN as a safety test. The test evaluates candidates’ ability to decide how to proceed in patient care situations, as opposed to strict memorization of answers to standard questions. The candidate can expect scenarios posing complex decisions that require cultural competence and use of available resources. NCLEX-RN seeks to present situations that occur in real health-care settings. There is an increased focus on client acuity and nursing management of change in condition. The goal is improvement in care that avoids medical errors by emphasizing clinical judgment and promoting optimal patient outcomes.