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NCLEX-RN Exam Format | Course Contents | Course Outline | Exam Syllabus | Exam Objectives

THE NCLEX-RN® EXAM
The National Council Licensure Examination (NCLEX-RN® exam) has one purpose: To determine if it's safe for you to begin practice as an entry-level nurse. It is significantly different from any test that you took in nursing school. While nursing school exams are knowledge-based, the NCLEX-RN® tests application and analysis using the nursing knowledge you learned in school. You will be tested on how you can use critical thinking skills to make nursing judgments.

NCLEX-RN® TEST FORMAT
FRAMEWORK
The NCLEX-RN® exam is organized according to the framework, "Meeting Client Needs." There are four major categories and eight subcategories. Many nursing programs are based on the medical model where students take separate medical, surgical, pediatric, psychiatric, and obstetric classes. However, on the NCLEX-RN® exam, all of the content is integrated.

TYPES OF QUESTIONS
Questions are primarily multiple-choice with four possible answer choices; however, there are also alternate question types. Alternate question types include multiple-response, fill-in-the-blank, hot spots, chart/exhibit and drag-and-drop. All questions involve integrated nursing content.

Let's look at the following question:

A 23-year-old woman with insulin dependent diabetes mellitus (IDDM) is returned to the recovery room one hour after an uneventful delivery of a 9 lb., 8 oz., baby boy. The nurse would expect the woman's blood sugar to

- rise
- fall
- remain stationary
- fluctuate
Is this an obstetrical question or a medical/surgical question- In order to select the correct answer, (2), you must consider the pathophysiology of diabetes along with the principles of labor and delivery.

SAFE AND EFFECTIVE CARE ENVIRONMENT
The first Client Needs Category, Safe and Effective Care Environment, includes two concepts:

Management of Care accounts for 17-23% of questions on the NCLEX-RN® exam. Some of the nursing actions included in this subcategory are Advanced Directives, Advocacy, Case Management, Client Rights, Concepts of Management, Confidentiality, Continuity of Care, Quality Improvement, Delegation, Establishing Priorities, Ethical Practice, Informed Consent, Legal Responsibilities, Referrals, and Supervision.

Safety and Infection Control accounts for 9-15% of exam questions. Nursing actions include Accident Prevention, Error Prevention, Hazardous Materials, Surgical Asepsis, Standard Precautions, and Use of Restraints.

HEALTH PROMOTION AND MAINTENANCE
The second Client Needs Category is Health Promotion and Maintenance. These questions account for 6-12% of the exam. Nursing actions tested include the Aging Process, Ante/Intra/Postpartum and Newborn Care, Developmental Stages and Transitions, Disease Prevention, Health Screening, Lifestyle Choices, Physical Assessment Techniques, Health Promotion Programs, High Risk Behaviors, and Self-Care.

PSYCHOSOCIAL INTEGRITY
The third Client Needs Category is Psychosocial Integrity. It accounts for 6-12% of the exam and tested nursing actions include Coping Mechanisms, Grief and Loss, Mental Health Concepts, Spiritual Influence on Health, Sensory/Perceptual Alterations, Stress Management, Support Systems, Therapeutic Communication, Chemical Dependency, Behavioral Interventions, Crisis Intervention, Coping Mechanisms, End of Life Care, and Family Dynamics.

PHYSIOLOGICAL INTEGRITY
The final Client Needs Category is Physiological Integrity. It includes four concepts:

Basic Care and Comfort accounts for 6-12% of questions on the NCLEX-RN® exam. Nursing actions included in this subcategory are Assistive Devices, Elimination, Mobility, Nonpharmacological Comfort Interventions, Nutrition and Oral Hydration, Personal Hygiene, as well as Rest and Sleep.

Pharmacological and Parenteral Therapies accounts for 12-18% of the exam. Tested nursing actions include Adverse Effects, Contraindications, Blood and Blood Products, Central Venous Access Devices, Chemotherapy, Expected Effects, Intravenous Therapy, Medication Administration, Pharmacological Pain Management, Total Parenteral Nutrition, and Dosage Calculation.

Reduction of Risk Potential accounts for 9-15% of the exam. Its tested nursing actions include Diagnostic Tests, Laboratory Values, Potential for Complications from Surgical Procedures and Health Alterations, as well as Therapeutic Procedures.

Physiological Adaptation accounts for 11-17% of the exam. Its tested nursing actions include Alterations in the Body Systems, Fluid and Electrolyte Imbalances, Hemodynamics, Medical Emergencies, Pathophysiology, and Unexpected Response to Therapies.

NCLEX-RN® GRADING SYSTEM
PASS/FAIL
The NCLEX-RN® exam is pass/fail—there is no numerical score. A determination will be made at the conclusion of the exam as to whether you have passed or failed. However, the results will not be made available at the exam site. You'll be notified by your State Board of Nursing approximately 2-4 weeks after your test date.

Your first step is to submit an application to the National Council of State Boards of Nursing (NCSBN). You will be required to follow the procedures established by the individual State Boards of Nursing. Some states have combined registration for the NCLEX-RN® exam with the application for licensure. In all other states, you must apply for licensure with the State Board of Nursing in the state in which you wish to become licensed. Once you have applied, you will receive a Candidate Bulletin to register for the NCLEX-RN® exam.

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National Council Licensure Examination (NCLEX-RN)
- 2023
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Question: 1661
When teaching a sex education class, the nurse identifies the most common STDs in the United States as:
A. Chlamydia
B. Herpes genitalis
C. Syphilis
D. Gonorrhea
Answer: A
Explanation:
(A) Chlamydia trachomatis infection is the most common STD in the United States. The Centers for Disease
Control and Prevention recommend screening of all high-risk women, such as adolescents and women with
multiple sex partners. (B) Herpes simplex genitalia is estimated to be found in 5-20 million people in the United
States and is rising in occurrence yearly. (C) Syphilis is a chronic infection caused by Treponema pallidum. Over
the last several years the number of people infected has begun to increase. (D) Gonorrhea is a bacterial infection
caused by the organism Neisseria gonorrhoeae. Although gonorrhea is common, chlamydia is still the most
common STD.
Question: 1662
A 30-year-old male client is admitted to the psychiatric unit with a diagnosis of bipolar disorder. For the last 2
months, his family describes him as being "on the move," sleeping 34 hours nightly, spending lots of money, and
losing approximately 10 lb. During the initial assessment with the client, the nurse would expect him to exhibit
which of the following?
A. Short, polite responses to interview questions
B. Introspection related to his present situation
C. Exaggerated self-importance
D. Feelings of helplessness and hopelessness
Answer: C
Explanation:
(A) During the manic phase of bipolar disorder, clients have short attention spans and may be abusive toward
authority figures. (B) Introspection requires focusing and concentration; clients with mania experience flight of
ideas, which prevents concentration. (C) Grandiosity and an inflated sense of self-worth are characteristic of this
disorder. (D) Feelings of helplessness and hopelessness are symptoms of the depressive stage of bipolar disorder.
Question: 1663
A client has been diagnosed as being preeclamptic. The physician orders magnesium sulfate. Magnesium sulfate
(MgSO4) is used in the management of preeclampsia for:
A. Prevention of seizures
B. Prevention of uterine contractions
C. Sedation
D. Fetal lung protection
Answer: A
Explanation:
(A) MgSO4 is classified as an anticonvulsant drug. In preeclampsia management, MgSO4 is used for prevention of
seizures. (B) MgSO4 has been used to inhibit hyperactive labor, but results are questionable. (C) Negative side
effects such as respiratory depression should not be confused with generalized sedation. (D) MgSO4 does not affect
lung maturity. The infant should be assessed for neuromuscular and respiratory depression.
Question: 1664
The predominant purpose of the first Apgar scoring of a newborn is to:
A. Determine gross abnormal motor function
B. Obtain a baseline for comparison with the infant�s future adaptation to the environment
C. Evaluate the infant�s vital functions
D. Determine the extent of congenital malformations
Answer: C
Explanation:
(A) Apgar scores are not related to the infant�s care, but to the infant�s physical condition. (B) Apgar scores assess
the current physical condition of the infant and are not related to future environmental adaptation. (C) The
purpose of the Apgar system is to evaluate the physical condition of the newborn at birth and to determine if there
is an immediate need for resuscitation. (D) Congenital malformations are not one of the areas assessed with Apgar
scores.
Question: 1665
A pregnant woman at 36 weeks� gestation is followed for PIH and develops proteinuria. To increase protein in her
diet, which of the following foods will provide the greatest amount of protein when added to her intake of 100 mL
of milk?
A. Fifty milliliters light cream and 2 tbsp corn syrup
B. Thirty grams powdered skim milk and 1 egg
C. One small scoop (90 g) vanilla ice cream and 1 tbsp chocolate syrup
D. One package vitamin-fortified gelatin drink
Answer: B
Explanation:
(A) This choice would provide more unwanted fat and sugar than protein. (B) Skim milk would add protein. Eggs
are good sources of protein while low in fat and calories. (C) The benefit of protein from ice cream would be
outweighed by the fat content. Chocolate syrup has caffeine, which is contraindicated or limited in pregnancy. (D)
Although most animal proteins are higher in protein than plant proteins, gelatin is not. It loses protein during the
processing for food consumption.
Question: 1666
The physician recommends immediate hospital admission for a client with PIH. She says to the nurse, "It�s not so
easy for me to just go right to the hospital like that." After acknowledging her feelings, which of these approaches
by the nurse would probably be best?
A. Stress to the client that her husband would want her to do what is best for her health.
B. Explore with the client her perceptions of why she is unable to go to the hospital.
C. Repeat the physician�s reasons for advising immediate hospitalization.
D. Explain to the client that she is ultimately responsible for her own welfare and that of her baby.
Answer: B
Explanation:
(A) This answer does not hold the client accountable for her own health. (B) The nurse should explore potential
reasons for the client�s anxiety: are there small children at home, is the husband out of town? The nurse should aid
the client in seeking support or interventions to decrease the anxiety of hospitalization. (C) Repeating the
physician�s reason for recommending hospitalization may not aid the client in dealing with her reasons for anxiety.
(D) The concern for self and welfare of baby may be secondary to a woman who is in a crisis situation. The nurse
should explore the client�s potential reasons for anxiety. For example, is there another child in the home who is ill,
or is there a husband who is overseas and not able to return on short notice?
Question: 1667
What is the most effective method to identify early breast cancer lumps?
A. Mammograms every 3 years
B. Yearly checkups performed by physician
C. Ultrasounds every 3 years
D. Monthly breast self-examination
Answer: D
Explanation:
(A) Mammograms are less effective than breast self-examination for the diagnosis of abnormalities in younger
women, who have denser breast tissue. They are more effective forwomen older than 40. (B) Up to 15% of early-
stage breast cancers are detected by physical examination; however, 95% are detected by women doing breast
self-examination. (C) Ultrasound is used primarily to determine the location of cysts and to distinguish cysts from
solid masses. (D) Monthly breast self-examination has been shown to be the most effective method for early
detection of breast cancer. Approximately 95% of lumps are detected by women themselves.
Question: 1668
Which of the following risk factors associated with breast cancer would a nurse consider most significant in a
client�s history?
A. Menarche after age 13
B. Nulliparity
C. Maternal family history of breast cancer
D. Early menopause
Answer: C
Explanation:
(A) Women who begin menarche late (after 13 years old) have a lower risk of developing breast cancer than
women who have begun earlier. Average age for menarche is 12.5 years. (B) Women who have never been
pregnant have an increased risk for breast cancer, but a positive family history poses an even greater risk. (C) A
positive family history puts a woman at an increased risk of developing breast cancer. It is recommended that
mammography screening begin 5 years before the age at which an immediate female relative was diagnosed with
breast cancer. (D) Early menopause decreases the risk of developing breast cancer.
Question: 1669
The nurse practitioner determines that a client is approximately 9 weeks� gestation. During the visit, the practitioner
informs the client about symptoms of physical changes that she will experience during her first trimester, such as:
A. Nausea and vomiting
B. Quickening
C. A 68 lb weight gain
D. Abdominal enlargement
Answer: A
Explanation:
(A) Nausea and vomiting are experienced by almost half of all pregnant women during the first 3 months of
pregnancy as a result of elevated human chorionic gonadotropin levels and changed carbohydrate metabolism. (B)
Quickening is the mother�s perception of fetal movement and generally does not occur until 1820 weeks after the
last menstrual period in primigravidas, but it may occur as early as 16 weeks in multigravidas. (C) During the first
trimester there should be only a modest weight gain of 24 lb. It is not uncommon for women to lose weight during
the first trimester owing to nausea and/or vomiting. (D) Physical changes are not apparent until the second
trimester, when the uterus rises out of the pelvis.
Question: 1670
A client is 6 weeks pregnant. During her first prenatal visit, she asks, "How much alcohol is safe to drink during
pregnancy?" The nurse�s response is:
A. Up to 1 oz daily
B. Up to 2 oz daily
C. Up to 4 oz weekly
D. No alcohol
Answer: D
Explanation:
(A, B, C) No amount of alcohol has been determined safe for pregnant women. Alcohol should be avoided owing to
the risk of fetal alcohol syndrome. (D) The recommended safe dosage of alcohol consumption during pregnancy is
none.
Question: 1671
A 38-year-old pregnant woman visits her nurse practitioner for her regular prenatal checkup. She is 30 weeks�
gestation. The nurse should be alert to which condition related to her age?
A. Iron-deficiency anemia
B. Sexually transmitted disease (STD)
C. Intrauterine growth retardation
D. Pregnancy-induced hypertension (PIH)
Answer: D
Explanation:
(A) Iron-deficiency anemia can occur throughout pregnancy and is not age related. (B) STDs can occur prior to or
during pregnancy and are not age related. (C) Intrauterine growth retardation is an abnormal process where fetal
development and maturation are delayed. It is not age related. (D) Physical risks for the pregnant client older than
35 include increased risk for PIH, cesarean delivery, fetal and neonatal mortality, and trisomy.
Question: 1672
A client returns for her 6-month prenatal checkup and has gained 10 lb in 2 months. The results of her physical
examination are normal. How does the nurse interpret the effectiveness of the instruction about diet and weight
control?
A. She is compliant with her diet as previously taught.
B. She needs further instruction and reinforcement.
C. She needs to increase her caloric intake.
D. She needs to be placed on a restrictive diet immediately.
Answer: B
Explanation:
(A) She is probably not compliant with her diet and exercise program. Recommended weight gain during second
and third trimesters is approximately 12 lb. (B) Because of her excessive weight gain of 10 lb in 2 months, she
needs re-evaluation of her eating habits and reinforcement of proper dietary habits for pregnancy. A 2200-calorie
diet is recommended for most pregnant women with a weight gain of 2730 lb over the 9-month period. With rapid
and excessive weightgain, PIH should also be suspected. (C) She does not need to increase her caloric intake, but
she does need to re-evaluate dietary habits. Ten pounds in 2 months is excessive weight gain during pregnancy,
and health teaching is warranted. (D) Restrictive dieting is not recommended during pregnancy.
Question: 1673
Diabetes during pregnancy requires tight metabolic control of glucose levels to prevent perinatal mortality. When
evaluating the pregnant client, the nurse knows the recommended serum glucose range during pregnancy is:
A. 70 mg/dL and 120 mg/dL
B. 100 mg/dL and 200 mg/dL
C. 40 mg/dL and 130 mg/dL
D. 90 mg/dL and 200 mg/dL
Answer: A
Explanation:
(A) The recommended range is 70120 mg/dL to reduce the risk of perinatal mortality. (B, C, D) These levels are
not recommended. The higher the blood glucose, the worse the prognosis for the fetus. Hypoglycemia can also
have detrimental effects on the fetus.
Question: 1674
A 25-year-old client believes she may be pregnant with her first child. She schedules an obstetric examination with
the nurse practitioner to determine the status of her possible pregnancy. Her last menstrual period began May 20,
and her estimated date of confinement using N�gele�s rule is:
A. March 27
B. February 1
C. February 27
D. January 3
Answer: C
Explanation:
(A)March 27 is a miscalculation. (B) February 1 is a miscalculation. (C) February 27 is the correct answer. To
calculate the estimated date of confinement using Nagele�s rule, subtract 3 months from the date that the last
menstrual cycle began and then add 7 days to the result. (D) January 3 is a miscalculation.

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