I noticed that my ESL buddies in nursing school had a more difficult time with the tests, i.e. the HESIs. I remember one coming out and frustratedly asking, "What is 'prudent'?" I don't THINK the hang-up is content, because these same ESL folks seemed to master the concepts of the systems in med-surg very well, they were all very intelligent, it seemed to me to be more a matter of grasping the core of what the question is asking. I am probably not the best person to answer this, I can only imagine what it's like from your perspective, but I felt like the questions in the Saunders study guide I used were fairly on par with the questions on the NCLEX. I personally would vote for it being a matter of interpretation of the question, and not a matter of you learning the info. I also know that a couple of my ESL friends took a lot longer on the tests (and did well on them), I only point that out to say that even though the test is timed for 6 hours, and you COULD end up with 265 questions, wouldn't it be better if you took a bit longer on the questions and answered them well, and the exam ended at 75-100 questions, than to feel rushed because you MIGHT have 265 (and therefore feel like you better take no longer than one minute per question)......in other words, take your time on the questions, don't let yourself feel rushed. Just some thoughts, best of luck in your study efforts.