Step One: Familiarizing the NCLEX-RN Test Plan

As a newly-licensed, entry-level registered nurse, you will need to practice nursing care safely and effectively. In order for you to perform safe and effective nursing care, you need to meet the competencies expected of you and this can be measured through the NCLEX-RN or the National Council Licensure Examination for Registered Nurses. How then will you be able to obtain this license to practice? You will need to pass the NCLEX-RN.  For you to ensure that you will pass NCLEX-RN, you need adequate preparation.

You have got to take at least one step to get to where you want to go. This one small step marks your initial preparation: familiarizing the NCLEX-RN Test Plan. The NCLEX-RN Test Plan serves as a guide for your preparation. It summarizes the content and scope of the examination. It will also tell you what cognitive abilities in you will be tested and explains the components that are organized into four major Client Needs categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity. The NCLEX-RN Test Plan also describes the integrated processes such as the nursing process, caring, communication, documentation, teaching/learning, culture, and spirituality.


What are the Cognitive Abilities being measured?

Nursing as a practice discipline requires application of your knowledge, skills, and abilities. Majority of the test items in the NCLEX-RN measure your higher levels of cognitive ability as a nurse. The levels of cognitive ability that will be measured are: knowledge, comprehension, application, and analysis. Since nursing practice requires critical thinking skills when making decisions, most of the NCLEX questions are application and analysis type of questions.


Here are two sample NCLEX questions taken from Silvestri (2005) that measure the application and analysis levels of cognitive ability:

Sample Question 1

Level of Cognitive Ability: Application

A client is experiencing a hypoglycemic reaction. The nurse should administer which of the following items to best treat the reaction?

  1. Water
  2. Diet soda
  3. Milk
  4. One sugar-free cookie


Answer: 3

When answering an application type of NCLEX question, the question usually asks for a nursing action, or intervention, a decision, or a problem that needs a solution. In the question above, you are asked to select the best treatment for hypoglycemia. You will be able to answer this correctly when you recall that a client with hypoglycemic reaction needs to take in drinks that contains 10 to 15 grams of carbohydrate.


Sample Question 2

Level of Cognitive Ability: Analysis

The nurse administers 10 units of Regular Insulin at 7:00 AM to a client with Type 1 diabetes mellitus. The nurse monitors the client most closely for a hypoglycemic reaction during which time frame?

  1. 9:00 AM to 10:00 AM
  2. 1:00 PM to 7:00 PM
  3. 9:00 AM to 3:00 PM
  4. 11:00 AM to 12:00 PM


Answer: 1

When answering correctly an analysis type of question, you need to integrate several concepts covered in the question. In the question above, recall that Regular insulin is a short-acting insulin that peaks in 2 to 3 hours. Recall also that hypoglycemic reactions most likely occur during peak time of drug action. Thus, the peak time of the short-acting insulin is most likely the time for a hypoglycemic reaction to occur.


There are also knowledge and comprehension type of questions in the NCLEX-RN, but majority of the questions are application and analysis types. You need to practice answering sample questions so that you will get used to the strategy or the techniques of answering these application and analysis types of questions.


What composes the Client Needs categories?


The Test Plan Framework of the NCLEX-RN is based on Client Needs. The Client Needs categories and subcategories identified by the (NCSBN) include:


  1. Safe and Effective Care Environment
  2. Management of Care

Questions under this subcategory may include the following content:

  1. Advance directives
  2. Case management
  3. Client advocacy
  4. Client rights (confidentiality and informed consent)
  5. Collaboration and consultation with interdisciplinary team
  6. Continuity of care
  7. Delegation, supervision, and management concepts
  8. Establishing priorities
  9. Ethical Practice
  10. Information Technology
  11. Legal rights and responsibilities
  12. Organ donation
  13. Performance improvement (quality improvement)
  14. referrals


  1. Safety and Infection Control

Questions under this subcategory may include the following content:


  1. Accident/error/injury prevention
  2. disaster planning and emergency response
  3. ergonomic principles
  4. handling hazardous and infectious materials
  5. home safety
  6. reporting of incident/event/irregular occurrence/variance
  7. use of restraints and safety devices
  8. safe use of equipment
  9. security plan
  10. standard precaution, transmission-based precaution, and surgical asepsis


  1. Health Promotion and Maintenance

Questions under this Client Need category may include the following content:

  1. Disease prevention
  2. Health promotion
  3. Aging process
  4. Maternal care and newborn care
  5. Developmental stages and transitions
  6. Health screening
  7. High risk behaviors
  8. Lifestyle choices
  9. Self-care
  10. Techniques of physical assessment


  1. Psychosocial Integrity

Questions under this Client Need category may include the following content:

  1. Abuse or neglect
  2. Behavioral interventions
  3. Chemical and other dependencies/substance use disorder
  4. Coping mechanisms
  5. Crisis intervention
  6. Cultural awareness/cultural influences on health
  7. End-of-life care
  8. Family dynamics
  9. Grief and loss
  10. Mental health concepts
  11. Religious and spiritual influences on health
  12. Sensory/perceptual alterations
  13. Stress management
  14. Support systems
  15. Therapeutic communication
  16. Therapeutic environment


  1. Physiological Integrity
  2. Basic Care and Comfort

Questions under this subcategory may include the following content:

  1. Assistive devices
  2. Elimination
  3. Personal Hygiene
  4. Mobility and immobility
  5. Nonpharmacological comfort interventions
  6. Nutrition and oral hydration
  7. Rest and sleep


  1. Pharmacological and Parenteral Therapies

Questions under this subcategory may include the following content:

  1. Blood and blood products
  2. Central venous access devices
  3. Dosage calculation
  4. Expected actions and outcomes
  5. Intravenous therapy and parenteral fluids
  6. Medication administration
  7. Pharmacological agents, actions, contraindications, interactions, side effects, and adverse effects
  8. Pharmacological pain management
  9. Total parenteral nutrition


  1. Reduction of Risk Potential

Questions under this subcategory may include the following content:

  1. Diagnostic tests and laboratory values
  2. Potential for alterations in body systems
  3. Potential for complications of diagnostic tests, treatments and procedures
  4. System specific assessments
  5. Therapeutic procedures
  6. Changes or abnormalities in Vital signs
  7. Potential for complications from surgical procedures and health alterations


  1. Physiological Adaptation

Questions under this subcategory may include the following content:

  1. Alterations in body systems
  2. Fluid and electrolyte imbalances
  3. Hemodynamics and illness management
  4. Medical emergencies
  5. Pathophysiology
  6. Unexpected responses to therapy


The Table below shows the Client Needs categories, subcategories, and the percentage of test questions.


Client Needs categories, subcategories, & percentage (%) of Questions
Categories/Subcategories Questions (%)
Safe, Effective Care Environment

Management of Care

Safety and Infection Control


17% – 23%

9% – 15%

Health Promotion and Maintenance 6% – 12%
Psychosocial Integrity 6% – 12%
Physiological Integrity

     Basic Care and Comfort

Pharmacological and Parenteral Therapies

Reduction of Risk Potential

Physiological Adaptation


6% – 12%

12% – 18%

13% – 19%

11% – 17%


What are the Integrated Processes?


Fundamental to the practice of nursing are four processes identified by NCSBN as: Caring, Communication and Documentation, Nursing Process, and Teaching/Learning. These integrated processes are a component of the NCLEX-RN Test Plan. They are integrated throughout the four Client Needs categories: Safe Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiologic Integrity.


  1. Nursing Process
  2. Caring
  3. Communication and Documentation
  4. Teaching/Learning
  5. Culture and Spirituality



NCSBN. (2016). NCLEX-RN Examination: Test Plan for the National Council Licensure Examination for Registered Nurses. Retrieved from

Silvestri, L. A. (2005). Strategies for Success for the NCLEX-RN Examination. Philadelphia, Pennsylvania, USA: W.B. Saunders Company.

#NCLEX #ARCHERNCLEX #allnurses #nurses #nursesrock


How to prepare SMART for NCLEX – RN Exam?

How to Equip yourself for NCLEX-RN Examination

The most common reasons for delaying or not taking the National Council Licensure Examination for Registered Nurses (NCLEX-RN) include: lack of confidence in one’s ability to pass the examination, test anxiety, no adequate time to prepare for the examination, and expiration of registration or authority-to-test (ATT) letter. In the study conducted by Woo, Wendt, and Liu (2009), among 28 US-educated RN candidates, 25% expressed that they were not confident in their ability to pass the examination while among 243 internationally-educated RN candidates, 18% expressed that they did not have enough time to prepare for the NCLEX-RN examination.

Perhaps you feel the same right now. You want to delay taking the NCLEX-RN examination because you feel that you lack preparation. If this is the main reason, then you might just find this article very helpful.

  1. Obtain review materials for NCLEX-RN examination.

A study investigating the relationship between NCLEX-RN passing rate and lag time in taking NCLEX showed that NCLEX-RN candidates do delay taking the examination because of lack of preparation. The very first thing you need to do to equip yourself is to get the materials that will assist you in the preparation process. This can be in the form of books, journal articles, NCLEX-related blog posts (from credible sources), electronic resources, practice questions study guides, etc.


  1. Choose a mentor you can trust.

A mentor walks with you all the way from the very beginning until the time you finally receive your US-RN license. Your mentor can help you overcome your test anxiety and lack of confidence through constant and consistent encouragement and practice. Your mentor however, must remind you that delaying in taking the NCLEX-RN examination does not cause you to fail the examination.


  1. Improve your weakness, and develop your strengths.

According to the study of McGahee, Gramling, and Reid (2010), nursing schools give priority to the success of first-time NCLEX-RNs and that they recommend nursing schools to look for trends in student success and failure and help RN candidates to pass NCLEX-RN examination by adequately preparing them. In their literature review, they identified the most significant predictor of NCLEX-RN failure: lower grades in nursing theory courses. Additionally, NCLEX-RN success was related to higher grades in other major nursing courses or subjects and high grades in pathophysiology!

So, go back to your Transcript of Records. Which nursing courses or subjects were you weak? Which were your strengths? Grades may be predictors of failure or success in NCLEX-RN examination but that does not mean you cannot do anything about them. How then will you improve on areas where you are weak? Practice answering questions related to the subject area. That’s it. For those concepts where you are strong, do not neglect them altogether. Practice answering questions related to those strengths still but spend more time answering questions on those concepts that you are weak.


  1. Empower yourself through self-assessment and individualized plan of interventions.

According to Stark, Feikema, and Wyngarden (2002), this strategy of self-empowerment can lead you to lifelong achievement of your goals. This strategy can help you build your self-confidence that will help you prepare for your NCLEX-RN examination. The plan that you will make for yourself based on your own needs will give you confidence that success can be objectively attained. The following guidelines is adapted from the study of Stark, Feikema, and Wyngarden (2002):

Guide to Self-assessment
For each of the four areas, answer the following questions:


What are your strengths in this area? What needs further development in this area?

I.                    Content areas: Consider your work in nursing courses, assessment test results, work & life experiences.

II.                  Test-taking skills: Consider your previous experiences reading and understanding multiple choice questions and previous experience with computerized testing.

III.                Managing anxiety: Consider your responses at other stressful occasions. Have you ever had difficulty thinking clearly or panicked while taking a test?

IV.                Preparation for day of testing: Consider your schedule in the days before testing.

Consider family and work responsibilities, available support systems. Consider whether you have sufficient information about the testing process.


A Guide to Possible Interventions
I.                    Improving in content areas:

a.       Target specific areas of content: What content?

b.      How do you study best?

Study groups, independent study, tutoring, sit in on classes, computer    programs Select a review course or book.

Prepare a schedule: When and where will you study?

II.                  Improving test-taking skills:

a.       Learn strategies for taking multiple choice questions— Academic Student Services counseling or classes, NCLEX-RN® review courses and books, Web sites

b.      Develop strategies for taking computerized tests Practice taking NCLEX-RN®-style computer testing programs

III.                Managing test anxiety:

a.       Reduce stresses related to testing Prepare in advance—follow your plan and do not cram.

b.      Gain relaxation/coping skills

Select and practice mind/body techniques that are effective for you (eg, relaxation, meditation, visualization, deep breathing)

c.       Have a quiet spirit Nourish your own spirit, spiritual care for self (eg, prayer, scripture reading), accept spiritual care from others.

d.      Think positive! Surround yourself with positive people, practice positive self-talk.

IV.                Preparing for the day of testing:

a.       Practice self-care prior to testing.

Include adequate sleep, proper nutrition and hydration.

Locate testing site, know the rules for testing

Know what supplies will be required for testing

b.      Have balance in your life prior to testing

Study vs. work vs. recreation; Solitude vs. social support

c.       Clear your mind

Reduce demands on your attention, spend time in a natural environment daily.


Remember, delaying the time you will take the NCLEX-RN examination will only prolong your agony of wondering, waiting, and asking “what if” and thinking, “if only.” Delay in taking the NCLEX-RN examination does not imply failure, but it is better to just get it over with and jumpstart your career as US-RN with adequate preparation. You need to equip yourself for the examination. No one else can equip you holistically. Not even your mentor. Your mentor is there only to provide you with encouragement and boost your motivation. Every energy and enthusiasm must come from within you.

Start now. Gather review materials for the NCLEX-RN examination, choose a mentor you can trust, improve your weaknesses and develop your strengths, and empower yourself through self-assessment and implement your individualized plan of interventions for NCLEX-RN success!


Ada Woo, A. W. (2009). NCLEX Pass Rates: An Investigation Into the Effect of Lag Time and Retake Attempts. JONA’S Healthcare Law, Ethics, and Regulation, 23-26.

Mary Ann Stark, B. F. (2002). Empowering Students for NCLEX Success. NURSE EDUCATOR, 103-105.

Thayer W. McGahee, L. G. (2010). NCLEX-RN® Success: Are There Predictors. Southern Online Journal of Nursing Research.


Stress Management Strategies for Passing NCLEX-RN Exam

Stress Management Strategies for Passing NCLEX-RN Exam

Preparing to take the NCLEX-RN exam is stressful. The process of registering and applying for the examination is stressful. Not knowing the outcome of the examination is stressful. Although you know you are going to experience stress, you still need to face the challenge and deal with the stressful experience the healthy way. You need to manage your stress for you to achieve your goal of passing the NCLEX-RN examination. Here are some tried and tested strategies you can apply in managing your NCLEX associated stress.

  1. Manage yourself.

Yes, everything in this world begins with the self. All the other strategies for managing stress are futile if you cannot manage yourself. To manage yourself, you need some time to reflect on your strengths and weaknesses. What are you good at? What do you need to improve on? Are you a procrastinator? Are you optimistic or pessimistic? How do you respond to a stressful situation? What are your coping habits? Look within you and find that strength to begin facing the stressful preparation for the NCLEX-RN examination.


  1. Exercise regularly.

Increasing your physical activities allows for the body to improve its blood circulation and its toxins are released through the sweat. There is that rejuvenated feeling after exercising. This wonderful energy and vitality gives you the boost to fight the effects of stress. Find time for at least 30 minutes of exercise, three times a week or at least 10 minutes of daily exercise. Aerobic exercise helps release tension and stress. Walking helps you maintain a healthy weight, prevents heart disease, manages your blood pressure, strengthens your bones and muscles, improves your balance and coordination, and most especially improves your mood. It therefore makes you feel good while reviewing for the NCLEX-RN exam.


  1. Do not be a perfectionist.

Perfectionism is one source of avoidable stress. Set realistic standards for yourself and others, and learn to feel just fine with “good enough.” Start with something like reading a chapter of your review book or answering 50 questions in a day for a week without the urge of perfectly cleaning up your room or study area before you begin. Just start reviewing without the need to be perfectly clean, organized and tidy. After answering 50 questions and the result is not what you expected, do not be discouraged. It’s perfectly alright not to get an impressive score initially. What is important is that you are consistent in your review and practice questions and that you are persistent, not perfect.


  1. Improve your attitude.

Positive attitude is the key to success. Optimism fuels you to take small steps to get to where you want to go inspite of difficulties. Positivity allows you to reflect on the good things in your life and keeping a positive perspective drives you to do things you need to do in preparation for your NCLEX-RN examination. As a stress management strategy, a positive attitude helps you cope with stress in healthy ways. Positive attitude also makes it easier for you to accept things you cannot change. It is therefore necessary that you improve on your attitude by turning negativities to positivity. How do you do this? One way is to stop comparing yourself to others. Convince yourself that no matter what you will pass the NCLEX-RN exam whether it is your first time to take it, the second time, or the third. Regardless of how many attempts you made, you will make it this time. Do not dwell on your inadequacies, instead focus on improving your attitude. Focus on your strength and wonderful self. Perform positive affirmations and self-talk. Say, “I will pass the NCLEX-RN exam.” Remember “hakuna matata,” it means no worries. All is well.


  1. Time Management

Time management is only effective when you are able to manage yourself. When you do planning about the things you need to do daily, as much as possible be disciplined enough to stick to your planned schedule. If there are things that are out of your own control, learn to be flexible. Adjust your tasks and schedule. One important thing to remember when managing your time is the ability to determine which tasks are necessary, urgent, and not that important. Do those tasks that are really urgent first and then those that are necessary but not so urgent and last in the list should be those that can wait. When you are in dilemma which activity to prioritize, use Maslows Hierarchy of Needs. Activities that address physiological needs can be top in your list. Safety needs, love and belongingness, esteem, and self-actualization needs can follow in this order. Your NCLEX-RN examination preparation is one of your esteem needs as it relates to achievement and career. When you are in dilemma whether to attend the birthday party of your family member or practice answering NCLEX test questions, don’t feel so stressed out trying to squeeze in your NCLEX practice questions activity into your daily tasks. Go and enjoy your day with your family. Perhaps it can even uplift your spirit and make you do better on your practice test the next day. Don’t stress yourself trying to cram up activities all in one day. Take it one day at a time.


  1. Adequate sleep.

Not getting enough sleep will make you feel tired and you end up becoming unproductive with your time. Insufficient sleep is associated with heart disease, diabetes, and obesity. You don’t want to experience health problems while preparing for your NCLEX-RN exam, do you? With adequate sleep, you’ll have a better mood. With better mood, you’ll feel good studying or reviewing for your NCLEX-RN examination.

  1. Try to relax and recharge.

Relaxation decreases muscle tension, improves blood circulation, slows your breathing which in turn reduces oxygen demand, normalizes blood pressure, and heart rate. When you are relaxed, you’ll have more energy to study and practice answering questions for your NCLEX-RN examination. You will also have better sleep and enhanced immunity. When you are relaxed, you will have better concentration and focus. You can think better and critically. Most importantly, you will have better problem-solving abilities which are necessary when answering NCLEX test questions.


Go for a walk. Spend time with nature. Call your best friend. Have a good workout. Write in your journal or blog. Bake cookies and cake. Savor a cup of coffee or tea. Play with your pet or your baby. Water the plants in your garden. Curl up on the sofa with a good book. Light scented candles. Take a long bath. Listen to your favorite music. Watch a comedy movie. Get a massage.


  1. Express your feelings.

Talk to a friend who had been through the whole process of NCLEX-RN examination from registration, to application, to actually taking it.  It is very cathartic when you express your thoughts and feelings of anxiety. The friend who had been through NCLEX can empathize with you. Expressing your feelings can also help alleviate your stress related anxiety.

Remember to MEDITATE when dealing with stress associated with your NCLEX-RN examination preparation. Manage yourself, Exercise regularly, Do not be a perfectionist, Improve your attitude, Time management, Adequate sleep, Try to relax and recharge, and Express your feelings

#NCLEX #ArcherNCLEX #nursingschool #nurselife #nursingstudent #allnurses #nursesrock 

How to Eliminate Severe NCLEX-RN Test-Taking Anxiety

“How to Eliminate Severe NCLEX-RN Test-Taking Anxiety”


Test-taking anxiety occurs with fear of the unknown…unknown result of the examination. To do well on any exam, active anxiety control is needed. Mild anxiety is somewhat helpful because it can be a motivator that can push the candidate to take a test seriously and prepare adequately for it. Severe anxiety however can lead to negative consequences that can affect the test score. Here are some helpful tips on how to reduce if not, eliminate severe test-taking anxiety associated with NCLEX-RN examination.

  1. FOCUS

Focus on your goal. Your goal is to become an RN…an NCLEX-RN passer. Focus on that.


A positive attitude matters a lot. When thoughts like “What if I fail?” gets into your head, think of positive thoughts to interrupt the negative thoughts. When you start to question your ability to pass the NCLEX-RN examination, think about how you prepared for the examination. If you have reviewed and prepared adequately, then it is time to get it over with. Look forward to finally taking the examination and just get it done. Imagine yourself as an NCLEX passer and the things you want to do after the examination. Remember that worrying will not help you reduce your anxiety. So, when you begin to worry, start thinking positive and happy thoughts.

  1. RELAX

Before and during the examination, use guided imagery, meditation, and guided visualization as relaxation techniques to help decrease your feelings of anxiety. Play a soothing music days before you take the exam to help you feel calm. On the day of the examination, do deep breathing exercises and a five-minute meditation. This will help calm your nerves and allow for a better blood circulation.


Manage your stressors and your stress responses. Use stress management strategies when preparing for your NLCEX-RN examination. This will give you a sense of control over your test-anxiety. How do you do this? First, avoid unnecessary stress by learning to say “no.” Do not take more than you can handle. Second, limit the time you spend with people who are your stressors. Third, alter your environment to make it less stressful. Fourth, avoid conversations that make your blood boil. Fifth, list down your things to do and prioritize those that are necessary. Those that can wait or may be eliminated, don’t burden yourself trying to do them.


A well-nourished body can better cope with stressful situations. Eat your breakfast and choose nutritious meals that keep you energetic, not lethargic. Avoid too much caffeine in your diet and too much alcoholic beverages. Avoid foods that can trigger your allergic reactions or can upset your stomach. Avoid spicy foods and acidic foods.


Adequate sleep allows for rejuvenation of body cells that keep you going throughout the day. Sleep also fuels the mind to think clearly and critically. When you are able to manage your anxiety with relaxation techniques, you will be able to sleep well. Avoid stimulating your mind through gadgets and television when you try to go to sleep. If you need to dim the lights in order to fall asleep, then do it. If you need music to help you doze off to sleep, then listen to music. Whatever routine you need to do in order to fall asleep, do it.


Diversional activities such as chatting with a very close friend, watching a favorite movie, writing a blog post, watching a favorite TV show, reading a book, going for a walk, jogging or running, working out, writing a journal, playing with a pet, gardening, cooking or baking, getting a whole body massage, getting a hair rebond, a manicure or a pedicure, going for a bike ride, and many more can help you take your mind off worrying over your NCLEX-RN examination. Think of anything that can divert your from your exam.


An essential part of your test preparation is adequate review of the lessons you found hard in college. Reviewing some important topics you need to strengthen yourself with, can help alleviate your anxiety. Knowing the test framework and reviewing the techniques for answering NCLEX type of questions will help you build your self-confidence.


Practice answering NCLEX test questions on a computer. Time yourself if you need to. Score your results. Know the rationales in every test item and review the areas or topics where you are weak.


Visit your test site the day before you take your NCLEX-RN examination. Be familiar with the route from where you are staying to the testing center and how to get back to your accommodation. Not knowing where exactly to go on the day of the examination will only add up to your anxiety.

When your stress response is elevated beyond a certain level due to anxiety, your brain can lose the ability to think clearly and your memory function may be affected. This is not good for your NCLEX-RN examination. You have got to manage your stress response by alleviating your anxiety using the tips mentioned above. Remember to focus, think positive, relax, manage your stress response, eat healthy, sleep well, divert your worried mind, review and practice answering questions, and take a tour at your testing site. Learn to savor this experience and understand that whatever happens, everything you are going through has some life lessons for you and for other people. Keep the FAITH. Your NCLEX-RN license is within reach.



McDowell, B. M. (2008). KATTS: A Framework for Maximizing NCLEX-RN Performance. Educational Innovations, 183-186.

Oregon State University. (2011). Stress Management Strategies. Retrieved from