4.3 Bonus Material: Getting Ready for the NCLEX

Kathleen Straker, RN

This Bonus Chapter was provided, with permission, from Straker & Kelman’s (2007) book, Vital Skills: Study Strategies Every Nursing Student Must Know.

Preparing for the NCLEX-RN®

You’ve done it! You’ve graduated from nursing school. Now there’s one more thing to do before you are allowed to begin your career as a Registered Nurse. The National Council Licensing Examination (NCLEX­-RN®) is the test that all nurses must pass in order to be eligible for licensure. The exam is offered only as a com­puter-adaptive test. Therefore, if you are not familiar with computerized tests, part of your preparation will be to be­come comfortable with that format.

Plan Your Review Schedule

Depending on how much time you will have each week to devote to preparing for the NCLEX, you will probably need to begin your review two to four months before the exam date. Test preparation books and programs recommend 80 to 120 hours of study, review and practice questions. So, if you have twelve weeks to prepare, you will need to spend approximately 10 hours per week, if you have eight weeks to prepare, then you will need to spend approximately 15 hours per week, if you have six weeks you will need to spend about 20 hours per week, and so forth.

The NCLEX will provide another opportunity for you to use the category charts, flow charts and note cards you made for your classes. Since you created those notes and have studied from them before, they will make re­viewing and remembering what was in those classes much easier than using all new study materials with which you are unfamiliar.

Arrange to take the exam as soon as is practical after completing your coursework. Taking the exam while still in “school mode” will help increase your likelihood of success. Most nursing programs strongly encourage students to take the NCLEX within one to three months of graduation. Save that “celebration vacation” until after the exam! If possible, wait until after the NCLEX to start your new job or increase your workload, if you’ve been working.

The National Council of State Boards of Nursing has an excellent website (www.ncsbn.org) that provides the information you will need for registering to take the exam.

Review Courses to Prepare for the NCLEX

The main advantage of review courses is that they force you to set aside time to prepare for the exam. If your program offers assistance in preparing for the NCLEX, by all means take advantage of it. But you will still need to plan your own review schedule. No general review course can possibly address the individual needs of each student. It is your job to continue to take charge of your learning and develop your own review schedule that will ensure you are fully pre­pared for the exam.

What to Review First

Performance on the NCLEX is highly correlated with grades in nursing courses. That tells you:

  1. The content of nursing courses you have taken over the last two years will be on the NCLEX
  2. How much you learned in chose courses (and can still recall) will help you on the NLCEX

Begin planning your review schedule by looking back at the courses you have taken in nursing school. This will require some candid self assessment on your part. We recommend you begin your period of review with the topic that is most difficult for you (probably the one in which you received your lowest grade) and work towards the topics or areas that come more easily. This approach ensures that you will spend time on the areas that need the most work.

If you run out of time as you near the exam date, you’ll be glad you didn’t neglect your weaker areas to spend more time on your strong subjects. The point is to spend more time where you need the most review and spend less time where you need less review.

Students find some organ systems and medical spe­cialties more complicated than others. The cardiovascular system, fluid and electrolyte balance, and renal function are often considered more difficult topics. Your prior knowl­edge of the subject and your level of personal interest make the order in which you review the topics a highly individual process.

You’ve labored long and hard toward your goal. Keep up the great work during this final phase!

Exit Exams

Many nursing programs administer an exit exam before stu­dents are allowed to take the NCLEX. There is a high cor­relation on many exit exams with performance on the NCLEX, which means if you perform well on the exit exam you are more likely to perform well on the NCLEX.

If your schools gives an exit exam you may want to use the preparation strategies in this chapter to prepare for that exam. The results from the exit exam may then be used to help you focus your review and preparation strategies for the actual NCLEX.

 

Steps Actions to Take Done
Part One: Preparations
1 Locate and organize your nursing text books and class notes by subject.
2 Purchase or borrow one or two NCLEX review books with additional practice questions on CD-ROM. Many students say that they find the Saunders NCLEX review book to be the most helpful.

Note: If you are still having difficulty discerning what some test questions are “really” asking, refer to the book Successful Problem-Solving & Test-Taking for Beginning Nursing Students by Patricia Hoefler. It’s not just for beginning nursing students.

3 Make a list of every nursing course and the grade received (and test grades, if you have that information.) Based on this information, list areas to review. Begin with the one that needs the most work (i.e., has the lowest grade), second is the next lowest and so on).

Or, you may want to use the results from your exit exam. The results from that exam should give you an excellent idea of the areas that need more of your attention.

4 Use your personal calendar to choose an exam date. Preferably within three months of graduation.
Part Two: Schedule Review Time
5 On your review/study calendar, mark off any dates you cannot study between the start of your review and the exam date.
6 Beginning with the exam date, count backwards the number of days available between the start of review and testing date. How many hours on each of those days will you be able to study? Will that add up to the 80-120 hours recommended? If not, you may need to reschedule the exam date. Remember that the sooner you take the exam after graduation, the better.

Make sure you leave the week (or at least five days) prior to the exam open, with nothing scheduled. This will allow time for a general review of the material and will give you a little “flex time” in case an emergency arises that gets you off track for a day or two.

Part Three: Actual Review
7 Estimate the time you will allocate to each topic, allowing time to go over some areas again near the end. Use the recommended 80-120 hours of review as a general guideline ·when planning your schedule. The activities that will be included in your review sessions will vary, but should permit you to:

  1. Review your old charts, cards and other notes.
  2. Take a 100-itemNCLEX practice test.
  1. Read and make study notes on any content material not yet mastered.
  2. Self test over your own notes.
  3. Answer short sets of NCLEX practice questions.
  4. Review responses to practice questions.
  5. Determine if topic is mastered (85% or higher on practice questions and self tests). If a topic is not yet mastered, write the name of the topic on a “Final Review List.
  1. Repeat steps above as time allows and then move on to the next topic.

The CD that accompanies many of the review books will give you feedback on the type of question and content area. We suggest that you create a tracking grid to record the topics that have been reviewed and learned to the 85% criterion.

8 Once you have estimated the time you want to spend on each topic, re-count how many days and hours your review schedule allows. Is it enough? Do you need to change the start date for your review or the test date?

 

How to Use Practice Questions and Practice Exams

As a general rule, you will answer practice questions only af­ter you have reviewed a topic. Using questions as your main review tool will not provide the structure necessary to pin­ point how to best spend your time. Most review books have short (10-20) sets of questions that are well-suited for self­ testing. The longer tests (50-200 questions) should be used as practice exams and taken once or twice a week during your review period. Some exam preparation programs recommend that by the time you sit for the actual NCLEX, you should have answered 2,000-3,000 NCLEX-type questions.

� Case Study

Nicole is in her final semester of nursing school. She will graduate with a bachelor of science in nursing (BSN) in only a few weeks.

She has been using our study system since her first semester of nursing school and has a well-organized set of study notes to use as she begins preparing for the NCLEX.

Nicole has kept a record of her course grades (as well as individual exam scores for each course) so she knows where she needs to begin. She uses her list of course grades to help her decide which area will need the most review.

Nicole received her lowest grades during the first semester of the nursing program, while she was learning to adjust to the pace and the amount of material she was ex­pected to learn. Since she received her lowest grade in Phar­macology, she lists this as the first area she will review. She will pay particular attention to the topics that were covered in the first semester of this multi-semester course.

 

Semester I Courses Final Course Grade
Health History and Physical Assessment 88%
Pathophysiology I 83%
Adult Health Care 84%
Pharmacology I 80%
Fundamentals of Nursing 89%
Semester II Courses
Pathophysiology II 88%
Community Health 95%
Nursing Care of Families with Children 91%
Medical Surgical Nursing 88%
Mental Health Nursing 93%
Semester III Courses
Care of the Childbearing Family 93%
Pharmacology II 90%
Nursing Research 95%
Medical Surgical Nursing II (Theory) 89%
Medical Surgical Nursing II (Clinical) 96%
Semester IV Courses
Synthesis of Nursing Knowledge 94%
Nursing as a Profession Seminar 93%
Nurse as Manager 90%
Medical Surgical Nursing III 92%

 

The next subject that Nicole lists is Pathophysiology. She was among the many students who struggled with the concept of fluid and electrolyte balance, so that will be at the top of her list of topics to review in patho. One of her teachers pointed out that given the current diabetes epidemic, she could count on seeing several questions about diabetes on the NCLEX exam, so diabetes will be next on her list of things to review in patho. Finally, she knows that cardiovascular disease is likely to be addressed on the NCLEX, so that is the third main are on which she will focus.

Nicole will also review much of what was covered the first semester in Adult Health Care. These three courses continued through other semesters, and Nicole was able to master much of the later material, but she knows this is her chance to review and fill in some gaps in her knowledge from those first difficult months of nursing school. She has already purchased two highly-recommended NCLEX review books. She chose the ones that the students in the class ahead of her said were even harder than the actual NCLEX!

Scheduling

Next, Nicole gets out her calendar, so she can plan her re­ view schedule and choose a date to take the NCLEX. The job she plans to accept will begin two months after gradua­tion. She and her husband are planning a well-deserved va­cation after she takes the NCLEX and before her new job begins. That leaves her about six weeks between graduation and the start of her vacation.

Graduation is on May 15 so she looks at her calendar and counts forward to the date her new job will begin, which is July 10. Now, counting backward from July 10 she blocks out three days to get settled back in and rest after her vaca­tion. Continuing to count backwards she writes a “V’ on the eight days she and her husband will be out of town.

The next decision Nicole makes is how many days there should be between the date she takes the NCLEX and when they leave for their vacation. She decides that two days after the exam should give her plenty of time to get ready, so she counts back two days from the start of her vacation and writes a “P” on those two days. The “P” stands for preparation.

She then writes NCLEX lightly on her calendar. Now she has to figure out if she’s left herself enough time to cover all the topics before she takes the exam.

Nicole has already decided which courses and notes need to be reviewed. The review books indicate that she should spend between 80 and 120 hours in review and self­ test in order to be well prepared. She thinks that it is realis­ tic to study for about six hours per day, five days a week. If she puts in 30 hours per week, then she needs to schedule four weeks of study.

So, counting backwards from the tentative NCLEX date, she lands on the date of her graduation ceremony. Many of Nicole’s family and friends are coming to her graduation and there are at least two parties over the weekend that she plans to attend, so she knows either the NCLEX date or her study schedule will have to change.

Nicole sees that if she studies on two of the three Saturdays before the exam, she will be able to stick to her original NCLEX test date.

The scheduling is pretty tight, and she does not have much flexibility in how she will spend her time if any emergencies arise. After talking with her nursing school advisor, Nicole decides to spend eight hours a day studying for the first two weeks, in addition to studying on Saturdays, so she can build in a little bit of a cushion.

Nicole is busy planning for her pinning ceremony and graduation, and she knows she will not be able to do much (if any) studying before graduation, but with the advance work she has done, she will be ready to dive right into reviewing the material immediately after the celebra­tions are over.

Study and Review Begin

Nicole had a wonderful graduation weekend and is now starting her first day of study and review. She has drawn up a chart entitled “Final Review List” on which she will keep a record of any area that she does not receive at least an 85% in when she begins self testing.

Once graduation is over, Nicole calls the testing cen­ter to schedule the exam. Because she is calling several weeks in advance, Nicole is able to arrange to take the NCLEX on the date she has chosen.

Nicole had already identified Pharmacology as the subject to review first and has gathered her charts from the first semester. She can tell that some of them are not com­plete, so her first task is to update her charts so they contain all the information she needs to master. She uses her course textbook, the class handouts and the review books to fill in the gaps in her charts. It’s slow going and takes most of the morning. Nicole is a little discouraged. She decides to use productive self-talk and reminds herself that once she has re-worked her charts the rest will come more easily.

At the end of day one, Nicole has nearly finished updating her notes. She writes a “to do” list for tomorrow so she can get started quickly on the work. Finally, she pulls out her “NCLEX Study Hours” tracking grid and records that she has studied for eight hours today. Whew! A good start.

At the end of the first week Nicole is on track and feeling good about the progress she has made. Today she plans to take her first practice exam using the CD that came with a review book. This will be a 100 question exam and she is looking forward to seeing how well she does on the questions.

The score that she receives on the practice exam is a 70%, which is lower than she had expected. Nicole de­cides to examine the types of questions that she answered incorrectly. She discovers that the items she missed were mostly from topics she had not yet studied. That was good news! When she counted up the items relating only to the topics she had studied her score increased to 87%. Much better.

By the end of the third week Nicole has studied and reviewed each of the topics thoroughly. She is ready to spend the last week reviewing and self-testing in the areas she feels need a little more work. She has taken one or two full length practice exams each week during her preparation for the NCLEX, as well as short paper-and-pencil quizzes over the topics.

Final Review Time

In order to determine what areas still need work, she looks over her “Final Review List” and also takes another full length practice exam on the computer. This one has 200 questions, so it will be a test of her endurance as well as her knowledge of the material.

This will probably be her last full length practice exam, as she does not want to experience test-taking burn­ out prior to the big day of the NCLEX.

Nicole has learned that there are really two parts to taking the NCLEX. The first, and most important part, is learning the material thoroughly. The second part is learn­ing to answer the question chat the test item is asking, and not “read into” the question.

On the day before she is scheduled to take the NCLEX, Nicole begins the last phase of her preparation, the mental and the physical. She plans her meals for maxi­ mum nutrition and, even though she is feeling a little ner­vous, she will not skip any meals.

Nicole spends the day in light review and does not do any self testing. She goes for a nice, long walk mid-day and takes a hot bath at bedtime to help her relax. Nicole sets two alarm clocks and places them far from the bed so she will have to get up to turn them off. No chance of over­ sleeping tomorrow! And throughout the day she has been using productive self-talk to remind herself how well-pre­pared she is for the NCLEX.

Taking the NCLEX

On the morning of the NCLEX exam, Nicole eats an espe­cially nutritious breakfast, with plenty of protein and com­plex carbohydrates, and allows an extra half hour for her drive to the testing center. When she arrives at the testing center she is feeling a little nervous, but decides to channel that feeling into eagerness to show what she has learned. Nicole knows she is well-prepared and looks forward to her future as a Registered Nurse.

NCLEX Content and Format

Distribution of the Content

The NCLEX is an application-based test, which means you must apply basic science concepts to clinical situations. It is organized by the broad theme of “meeting clients’ needs”. The four major areas of the exam are:

  • Physiological Integrity
  • Safe and Effective Care Environment
  • Health Promotion and Maintenance
  • Psychosocial Integrity

You will be expected to analyze the information you have been learning for the last two (or more) years and apply it to clinical situations.

Make sure you have familiarized yourself with the most current list of topics and requirements issued by the National Council of State Boards of Nursing by visiting their website.

NCLEX Test Format

The NCLEX is administered using a computer-adaptive test­ing format. What that means is how you answer each test item will determine the level of difficulty of the next test item. The length of the exam is determined by the size of the sample that the software program requires to accurately de­termine the extent of your knowledge. The time limit for the entire exam is five hours, though most students say they are able to finish in about three to four hours. Currently the maximum number of exam questions is 145 and the minimum is 75.

No matter how many test questions you are given, 15 of them will be experimental items that are being tested for use in future exams. All standardized exams test future questions in this manner. These items will not count either for or against you in determining whether or not you pass the exam. But since you will not be told which questions are experimental, you must answer each question to the best of your ability.

The NCLEX will end when one of the following events has taken place:

  • The five hour time limit or the 145 question limit has been reached,
  • You have answered at least 75 questions and have passed the exam,
  • You have answered at least 75 questions and have not passed the exam.

The best strategy to use for this exam is to be well-prepared in terms of content and be familiar with answering NCLEX­ type questions on the computer-in that order.

To mentally prepare yourself, the best strategy is­- plan to be at the testing center for the full five hours and plan to answer all 145 questions.

Test Time

The Day Before the Exam

As noted in our case study, the best way to spend the day before the NCLEX is a combination of light review, good nutrition, moderate exercise and a full night’s rest-with a back-up alarm clock set, so there’s no chance of over­ sleeping.

The Day of the Exam

After a good night’s rest and a nutritious breakfast, plan to arrive at the testing center twenty to thirty minutes before your scheduled exam time. This will allow time for traffic delays on the way, and, once you arrive, will give you a few minutes to do some deep breathing exercises, make a bath­room stop and whatever else you need to do to finish pre­paring yourself mentally and physically.

Although you will not be allowed to carry anything into the exam room, you should plan to dress in a way that you will not be too hot or too cold, so you can fully concen­trate on answering questions. Many test centers are notori­ous for being uncomfortably over air-conditioned, especially in the summer months.

Most testing centers offer a number of standardized exams, such as those required for admission to law school, medical school or graduate school, so do not assume that the other people in the room with you are taking the NCLEX.

Examine your work station before you begin the exam. Make sure you can easily see the computer screen and that your chair is a comfortable height. If you have any computer difficulties during the exam, contact the room monitor or proctor immediately. They will need to make a report of anything that does not go according to the stan­dards set by the testing committee.

Instead of offering paper and pencil for students to use during standardized tests, many testing centers now pro­vide a small white board and marker. Find out which your testing center offers so you can use the same thing when taking practice NCLEX exams. You want to closely simu­late the actual conditions, so they will all be familiar to you on test day.

No matter how well you prepare, some unexpected topic or subject matter may be presented. If it is, use deep breathing and productive self talk to remain calm. Remind yourself that you are well prepared for this exam and will continue to focus on the questions in front of you.

If An Emergency Arises

Despite your best efforts, an emergency or other unforeseen event may occur on test day. If you are feeling ill, if you have a car accident or if you receive upsetting news as you walk out the door, it’s time to re-think your testing strategy.

Even though you will probably have to pay for the already scheduled exam, nursing faculty members say they advise students that it is much better to reschedule the NCLEX than to try and “gut it out” and take the test when physically ill or emotionally upset.

If an emergency does occur, call the exam center to let them know you will not be coming. Do what you can to rem­edy the situation and reschedule the exam as soon as possible.

 

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