The National Council Licensure Examination for Registered Nurses (NCLEX-RN®) is the licensing exam required to practice as a registered nurse in the United States. Administered by the National Council of State Boards of Nursing (NCSBN), the NCLEX-RN® tests your ability to apply nursing knowledge and clinical judgment to patient care situations. You must pass the NCLEX-RN® after completing an accredited nursing program (BSN or ADN) before you can receive your RN license and begin practicing. This page covers the exam format, the Next Generation NCLEX® changes, preparation strategies, and the best resources.
Next Generation NCLEX Changes
In April 2023, the NCSBN launched the Next Generation NCLEX® (NGN), which introduced new question types designed to better assess clinical judgment. In addition to traditional multiple-choice questions, the exam now includes enhanced item types such as extended drag-and-drop, cloze (dropdown) questions, matrix/grid questions, enhanced hotspot questions, and clinical judgment scenarios that present evolving patient situations requiring multiple decisions. These NGN items are scored using a partial-credit model, meaning you can earn points for partially correct answers rather than the previous all-or-nothing approach.
The introduction of NGN items means that memorization alone is no longer sufficient. The exam now emphasizes your ability to recognize cues in patient data, analyze and prioritize information, generate hypotheses about patient conditions, plan and implement appropriate interventions, and evaluate outcomes. Your nursing program should be incorporating clinical judgment training into its curriculum, but you should also practice with NGN-style questions during your NCLEX® preparation.
Exam Format and Structure
The NCLEX-RN® uses computerized adaptive testing (CAT), which means the computer adjusts the difficulty of questions based on your responses. If you answer a question correctly, the next question will typically be harder. If you answer incorrectly, the next question will be easier. The exam continues until the computer has enough information to determine with 95% confidence whether you are above or below the passing standard.
The minimum number of questions is 85, and the maximum is 150. The maximum time allowed is 5 hours. Most test-takers complete the exam in 2 to 4 hours with between 85 and 130 questions. Receiving the minimum number of questions (85) does not mean you passed or failed; it simply means the computer had enough data to make a determination.
Content is organized into four major client needs categories: Safe and Effective Care Environment (management of care, safety and infection control), Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity (basic care and comfort, pharmacological therapies, reduction of risk potential, physiological adaptation). Physiological Integrity and Safe and Effective Care Environment together account for the majority of exam content.
Registration and Scheduling
After graduating from your nursing program, you must apply for licensure through your state’s board of nursing and register for the NCLEX-RN® through Pearson VUE. Your nursing program will submit your educational credentials to the board of nursing. Once your application is approved, you will receive an Authorization to Test (ATT) email from Pearson VUE, which allows you to schedule your exam at a testing center. The exam fee is approximately $200. You must take the exam within the validity period of your ATT (typically 90 days).
Scoring
The NCLEX-RN® is scored as pass or fail. There is no numeric score. The passing standard is set by the NCSBN and is periodically reevaluated. The computerized adaptive algorithm determines whether your ability level is above or below the passing standard. Results are typically available within 48 hours through your state board of nursing or through the NCSBN Quick Results service (available for an additional fee approximately 2 business days after testing).
How to Prepare
Most nursing graduates study for 4 to 8 weeks after graduation before taking the NCLEX-RN®. We recommend scheduling your exam within 45 to 60 days of graduating to maintain the momentum of your nursing education. The longer you wait, the more content you will forget, and first-time pass rates are highest among students who take the exam soon after completing their program.
Recommended Study Resources (Free First)
NCSBN Learning Extension (Low Cost): The NCSBN offers an official NCLEX® review course through its Learning Extension platform. While not free, it is one of the most affordable comprehensive review options and is developed by the same organization that writes the exam. It includes content review, practice questions, and NGN-style items.
Khan Academy® (Free): Khan Academy® offers free content in health and medicine that covers many foundational concepts tested on the NCLEX-RN®, including pathophysiology, pharmacology, and anatomy. While not NCLEX®-specific, these resources are useful for content review. See our Khan Academy® guide.
Your Nursing Program’s Materials (Free): Your lecture notes, clinical skills documentation, and any NCLEX® preparation materials provided by your program are valuable review resources. Many nursing programs include NCLEX® preparation in their final semester, including practice exams and content reviews.
Free Practice Questions Online: Several nursing education websites offer free NCLEX-RN® practice questions. Focus on questions that include NGN-style items and clinical judgment scenarios. Practice answering questions under timed conditions to build the test-taking stamina you will need on exam day.
Question Banks and Review Courses (Paid): Comprehensive question banks with thousands of practice questions and detailed rationales are the most popular paid preparation tools. Some companies also offer live or on-demand review courses. We do not recommend specific products and do not place affiliate links. Choose based on recommendations from recent graduates of your nursing program.
Study Strategies
Prioritize Clinical Judgment: With the introduction of NGN, practice thinking through clinical scenarios systematically. For each patient scenario, ask yourself: What cues am I seeing? What do they mean? What could be happening? What should I do first? What outcome am I expecting? This systematic clinical reasoning framework is what the exam is designed to measure.
Focus on Pharmacology: Medication questions appear throughout the exam. Review major drug classes, mechanisms of action, common side effects, nursing considerations, and patient teaching points. Focus on medications you encountered during clinical rotations, as these are most likely to appear on the exam.
Practice Prioritization Questions: Many NCLEX-RN® questions ask you to prioritize nursing actions. Practice using frameworks like ABCs (airway, breathing, circulation), Maslow’s hierarchy of needs, and the nursing process (assessment, diagnosis, planning, implementation, evaluation) to determine the correct order of actions. When two or more actions seem correct, the exam is testing your ability to identify the one that should come first based on patient safety and clinical urgency.
Manage Test Anxiety: The adaptive format can cause anxiety because you cannot go back to previous questions, and you do not know how many questions you will receive. Practice under test-like conditions during your study period so the format feels familiar on exam day. Remind yourself that receiving fewer questions does not indicate failure, and receiving more questions does not indicate that you are struggling. The algorithm is simply gathering data.
For career context, see our registered nurse career profile and BSN vs. ADN comparison. For nurse practitioner pathways, see our nurse practitioner career profile.
References
National Council of State Boards of Nursing (NCSBN). “NCLEX-RN Examination.” NCSBN, 2025. https://www.ncsbn.org/nclex.page. Accessed March 2026.
National Council of State Boards of Nursing (NCSBN). “Next Generation NCLEX.” NCSBN, 2025. https://www.ncsbn.org/next-generation-nclex.page. Accessed March 2026.
Khan Academy. “Health and Medicine.” Khan Academy, 2025. https://www.khanacademy.org/science/health-and-medicine. Accessed March 2026.