The Most Common Question Types on the NCLEX-RN Exam

Did you know over 6 million nursing hopefuls have taken an NCLEX exam? No matter what state you live in, the NCLEX-RN exam is a critical part of becoming a registered nurse.

The current overall pass rate for all candidates is only around 70%. Your best chance is to pass the exam on the first try (88%). After that, the pass rate drops in half to around 50%.

The NCLEX-RN is challenging, but you can challenge it right back. By knowing the type of exam questions and studying accordingly, you can join the ranks of 3 million dedicated RNs across the U.S.

NCLEX-RN Exam Basics

The NCLEX-RN exam is managed by the National Council of State Boards of Nursing (NCSBN). It’s part of the nurse licensing process in many places:

All 50 U.S. states
District of Columbia (D.C.)
American Samoa
Guam
Northern Mariana Islands
U.S. Virgin Islands
Canada
Australia

Pearson VUE currently administers the exam at applicable testing centers. To take the test, you must register with both Pearson and your Nursing Regulatory Body (NRB).

In April of 2023 the exam was updated and rebranded as the Next Generation NCLEX (NGN). While the core of the test remains the same, changes include a greater emphasis on correct nursing actions with the introduction of case study questions, a smaller maximum question number and exam length, and the ability to earn partial credit.

Importance of the NCLEX-RN Exam

NCLEX exams determine if you have the necessary knowledge and abilities to perform nursing duties. This isn’t limited to standard academic benchmarks like reading levels. It also tests your critical thinking and analysis skills.

Every state has different requirements for earning your nursing license. However, you cannot get a nursing license in any state unless you pass the NCLEX-RN exam.

Even if you have an accredited nursing degree, there is no equivalent substitute for this exam. You cannot legally work in any job field that requires a nursing license without it, according to U.S. laws and regulations.

NCLEX-RN Testing Format

The exam mostly uses Computer Adaptive Testing (CAT) format. This format is dynamic, meaning your questions change depending on your answers:

Wrong answer -> next question is easier
Right answer -> next question is more difficult

This format does not allow test-takes to skip questions. You cannot go back and change your answers either. It’s important to consider each question carefully before selecting your final answer.

Many people answer the questions they know first and go back to more difficult questions later. The CAT format can be an adjustment if you’re used to this strategy.

If you’ve never taken a CAT test before, it’s recommended to try practice tests with this format to help you adjust. NCLEX-RN exam practice can also help reduce uncertainty and test anxiety.

NCLEX-RN Exam Questions

The NCLEX-RN uses Bloom’s Taxonomy Model to form questions and answers. It has six fundamental skill levels:

Remember
Understand
Apply
Analyze
Evaluate
Create

This model not only tests your basic knowledge but how you apply that knowledge to your nursing abilities. This includes all the appropriate ways you must:

Follow procedures
Evaluate clients
Analyze information
Assess situations
Make decisions
Solve problems
Communicate effectively
Prioritize care
Avoid safety issues

Memorization alone won’t ensure you answer all the NCLEX-RN exam questions correctly. You must also choose the proper responses to different situations. For this reason, many test-takers struggle with the exam, even if they study the exam material faithfully.

NCLEX-RN Exam Question Formats

You can boost your NCLEX-RN question-answer success by knowing how to break down the questions. Most questions follow the standard multiple choice format, but some questions use alternative formats.

1. Multiple Choice

Multiple choice questions (MCQs) are the standardized testing format of choice. Most people become familiar with MCQs in grade school. There are two main versions:

Only one answer is correct
More than one answer is correct

Your exam should clearly indicate when one only answer is correct vs. multiple answers. Multi-answer MCQs can also include answers such as “none of the above” or “all of the above.”

This format has three main parts:

Stem (question)
Correct answer(s)
Distractors (completely wrong answers)

Many MCQs also include an answer that is partially correct or close to the correct answer. This is to prevent you from guessing entirely if the distractors are obviously wrong.

The stem will generally contain all the relevant information you need to determine what type of answer is correct. This can include certain qualifying keywords, such as:

Always
Never
Best
Worst
Not
Except
Only
Every
None

These keywords can change the correct answer depending on how they’re used. For example, consider the difference between these questions and how the wording affects which answer will be correct:

Which factor impacts a client’s body temperature?
All of these factors can impact a client’s body temperatures, except:
Which factors can impact a client’s body temperature? Select all that apply.
Which factor has the most significant impact on a client’s body temperature? Choose the best answer.
What factor always impacts a client’s body temperature?
What factor(s) can impact a clients body temperature? More than one answer may be correct.

If you read too fast over the question, you may miss the wording differences that change an answer’s outcome. Around 60-80% of your test questions will be MCQs.

2. Fill-In-the-Blank

Some questions will not give you any answer choices at all. You must either calculate, remember, or deduce the correct answer from context and memory.

Most NCLEX-RN exam questions that fill in a blank will be mathematical calculations. For example, you may be asked to manually calculate an IV drip rate.

You may also have to convert between metric (kilo, mili, centri) and imperial (feet, cups, pounds) measurements. Always double-check what unit of measurement the question is asking for.

3. Ordered Response

As a nurse, you will need to follow proper step-by-step procedures. NCLEX-RN exam questions will make sure you know the right order of steps, scales, and phases.

For example, you may be asked to put the four phases of pain in sequential order. Or they might ask you to arrange the proper order of steps for inserting a catheter.

This question format may have you select only one answer like a standard multiple-choice question. It can also use a drag-and-drop function so you can arrange the answers appropriately.

4. Hot Spots

Anatomy and physiology are also important to nursing. Some NCLEX-RN NGN exam questions will ask you to identify certain areas accurately on a picture or chart, or to highlight portions of text that are correct.

For example, you may have to select the proper area to listen for a heart murmur. Or you may be asked to select an abnormality on an X-ray. These questions are similar to multiple-choice questions with graphics, so make sure to differentiate between hot spot questions and MCQs.

5. Case Studies

On the NCLEX-RN exam, 18 items will be dedicated to three in-depth clinical judgment case studies. New to the Next Generation NCLEX, this question type is based on the six domains of the NCSBN Clinical Judgment Measurement Model (NCJMM) to better assess the dynamic, evolving nature of nursing care. Unlike the rest of the exam, these questions are static and not computer adaptive. These questions will require test-takers to:

Recognize Cues: Spot important data from varied sources, like symptoms or medical records.
Analyze Cues: Understand the correlation between identified cues and the overall clinical scenario.
Prioritize Hypotheses: Rank potential scenarios by their urgency, risk, or other relevant factors.
Generate Solutions: Propose viable treatments or interventions as per the assessed situation.
Take Action: Execute on the top-priority interventions or solutions.
Evaluate Outcomes: Assess the actual results against the expected outcomes post-intervention.

Given that clinical judgment is a holistic process, these case studies will span across multiple intertwined areas, demanding not just recall but application and analytical skills. As you prepare, focus on how these domains interplay in real-world nursing contexts.

NCLEX-RN Exam Question Categories

The NCLEX-RN exam is grounded in the knowledge of four main nursing areas:

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

Some of these sections include subsections. A certain percentage of the test questions will be dedicated to each section and subsection.

1. Safe and Effective Care Environment

A client safety and comfort are paramount to healthcare success. This section ensures you can provide client care that is high-quality and effective. It contains the biggest percentage of questions overall.

Management of Care (15%-21%)

The Management of Care subsection will have questions about your responsibilities and your client’s rights. This includes:

Advance directives
Advocacy
Assignment, delegation, and supervision
Case management
Collaboration and management concepts
Confidentiality/information security
Continuity of care
Establishing priorities
Ethical practice
Informed consent
Legal rights and responsibilities
Information technology
Performance improvement
Referrals

This section asks you how to properly respond in client care scenarios. For example, you may be asked to prioritize incoming clients, comfort agitated loved ones or delegate tasks.

Safety and Infection Control (10%-16%)

The Safety and Infection Control section makes sure you know how to appropriately prevent, identify, and respond to safety and health hazards. It includes:

Prevention
Emergency response plan
Ergonomic principles
Hazardous materials
Home safety
Reporting Incidents
Safe equipment use
Security plan
Precautions
Restraints and safety devices
Surgical asepsis

These questions will include potential or actual hazards occurring in various client care scenarios. For example, you may be asked to identify the first step in cleaning up a hazardous material spill, or how to identify the signs of an infection.

2. Health Promotion and Maintenance (6%-12%)

The Health Promotion and Maintenance section goes over healthcare as it relates to the stages of human development. This includes:

Aging process
Pregnancy, birth, and newborn care
Developmental transitions and stages
Health promotion and disease prevention
Health screening
High-risk behaviors
Lifestyle choices
Self-care
Physical assessment techniques

Questions from this section will give you clients of various ages. You must select the best answer appropriate for their stage of growth and development.

3. Psychosocial Integrity (6%-12%)

The Psychosocial Integrity section recognizes that mental, emotional, and social care are just as important as physical care. This encompasses:

Abuse/neglect
Behavioral interventions
Coping mechanisms
Crisis intervention
Cultural awareness
End-of-life care
Family dynamics
Grief and loss
Mental health concepts
Religious and spiritual influences
Sensory/perceptual alterations
Stress management
Substance use
Support systems
Therapeutic communication and environment

For these questions, you’ll have to analyze client signs that point to issues like abuse, stress, and substance use. You may also be asked how to ensure proper care and support will not further risk client safety.

4. Physiological Integrity

This section is the largest by content. Physiological relates to the regular functions of a body’s system. This includes focusing on how to maintain everyday health and quality of life, as well as adjusting to health conditions.

Basic Care and Comfort (6%-12%)

The Basic Care and Comfort subsection goes over the promotion of good health practices, such as proper hygiene and nutrition. It includes:

Assistive devices
Elimination
Mobility and immobility
Non-pharmacological comfort interventions
Nutrition and oral hydration
Personal hygiene
Rest and sleep

The questions relating to this section will ask you to help clients find the most effective strategies for basic quality of life. This can mean reducing pain, encouraging exercise and movement, and assisting with impaired bodily functions.

Pharmacological and Parenteral Therapies (13%-19%)

The Pharmacological and Parenteral Therapies section deals with your nursing duties in medication and therapy. This means extensive knowledge of:

Medication effects
Blood and blood products
Central venous access devices
Dosage calculation
Expected actions and outcomes
Medication administration
Parenteral and intravenous therapies
Pharmacological pain management
Total Parenteral Nutrition (TPN)

These questions will make sure you know how to properly give medication to clients, and spot any signs of adverse reactions. It also quizzes you on how to choose and manage proper client therapies.

Reduction of Risk Potential (9%-15%)

The Reduction of Risk Potential subsection relates to the process of adjusting care to ensure you’re using the most effective and safe practices. This means knowing about:

Vital signs
Diagnostic tests
Laboratory values
Body system alterations
Complications of diagnostic tests, treatments, and procedures
Surgical procedures and health alterations
System specific assessments
Therapeutic procedures

Relevant questions test you on your ability to properly identify risk by age, health conditions, and other critical factors. You’ll also be asked how to identify and respond to risks as they occur.

Physiological Adaptation (11%-17%)

The last subsection, Physiological Adaption, seeks to maintain or support body functions for clients with serious and/or ongoing health issues. This includes:

Body systems alterations
Fluids and electrolytes
Hemodynamics
Illness management
Medical emergencies
Pathophysiology
Therapy responses

This subsection gives you client care scenarios where you must identify health conditions along with their causes and sources. You’ll also be asked to formulate the best responses and recommendations for the relevant condition.

How Long Is the NCLEX-RN Exam?

This material can look intimidating in list form. It may seem like you’ll be tested all day and into the night.

Fortunately, the NCLEX-RN Exam has a fairly standard test time. You’ll be given a maximum of five hours for completion, which includes the option for two short breaks.

The CAT testing format is dynamic, so you may not be asked every single question. Your question range will be from 85 (minimum) to 150 (maximum). The NCLEX also includes a run-out-of-time rule for takers who don’t finish on time.

Challenge the NCLEX-RN Exam

Many test-takers fail because they cannot passively read the material and still develop the skills needed to solve complex problems. You can master the exam by using effective study tools.

There are free NCLEX-RN practice exams that use questions similar to the official exam. They include relevant question formats and categories. This helps you hone your abilities along with cementing your foundational knowledge.

Your Nursing Career Is Waiting! Get Started on Mastering the Exam Today

The NCLEX-RN Exam can be a challenge if you aren’t prepared. Nurses can’t rely on memorizing facts and figures. They must respond to certain signs, situations, and scenarios to ensure the best healthcare outcomes.

Do you want to master the NCLEX-RN on your first try? We have all the resources you need to get started. Create your free account today!