Are You Ready for NCLEX? Think PATIENT SAFETY and You Will Be!

  1. This article talks about my experience taking the NCLEX, and teaching NCLEX test prep to recent graduates. It includes strategies for passing the NCLEX.

    Are You Ready for NCLEX? Think PATIENT SAFETY and You Will Be!


    I took my NCLEX way back in 2006 - before alternate items, but after select all that apply (those dreaded SAPs!!). I recall driving to the testing facility early in the morning in a state of terror- it was midsummer and I had just returned from a three-week vacation in Costa Rica. I didn't study AT ALL while I was on vacation. I studied for about a week after I returned - flipping through all my old textbooks and my notes. I had heard all the horror stories - getting "preselected" for 275 questions (not true)...taking all 6 hours...freezing into a permanent catatonic state from sheer boredom (kidding on that last one). I have always considered myself to be "smart", I did well in school, and all my classmates, friends and spouse were telling me "of course you will pass", yet I felt certain I would fail as I walked into the testing center. I locked my purse in a locker, and sat down in front of a computer screen. After running through some practice questions to ensure my ability to point and click correctly, the test began. I don't recall much about my questions (and you aren't supposed to talk about them anyway, so I won't), but I just kept thinking about the advice I had received...when in doubt, go with your gut - the answer is in your brain, whether you know it or not.

    I went with my gut A LOT. There were many questions I didn't know a thing about. There were some SAPs, there were some questions on pain, and some that asked me if I wanted to call the healthcare provider (ok, so I talked about it a little bit...) question 73 my hands started to shake and I couldn't get a deep breath in. My computer shut off at question 75 and I was 100% sure that I had failed. I left thinking, "I have NO idea what the answers were to MOST of those questions". Back in '06 you had to wait a few days to get your score - now you can get it in 48 hours if you pay an extra $8. It's all a blur, really - lost in the stress of having a job lined up and thinking about how to tell my future employers, and my family, "I didn't pass because I goofed around and didn't study and now I have to take it again and I am a giant loser." (I don't actually think people who don't pass the NCLEX are giant losers, but I am really mean to myself --I say things to myself I would NEVER say to another human being.) Despite all my worries, I did pass and have now been a nurse for 12 glorious years.


    Recently I took a job teaching NCLEX test-taking strategies to recent RN graduates. There are many options out there for prepping for the NCLEX that range from my strategy of basically doing nothing (not recommended) to in-person, intensive test preparation. You can do your test prep online, you can hire an individual tutor, your school may require test prep, or it might strongly recommend it, or they may not even mention it - there is no required preparation for the NCLEX. Now that I have taught an NCLEX test prep course, however, I have ONE major recommendation:

    1. Take an NCLEX test prep course!!!!

    Really do it. It is worth the money for the peace of mind you will have.

    The company I work for required me to analyze hundreds of NCLEX style questions using a standardized method that I think makes a lot of sense. As I was working through the test questions, I began to understand the NCLEX in a way I never had before, and it began to make so much more sense. I used to be pretty snotty about the NCLEX, saying things like "Yeah, it makes soooo much sense to give a nurse a license after taking a multiple choice test, the NCLEX really tests your ability to take care of patients..."please coat my quote with snarky sarcasm, while hearing that I realize I was wrong. I think the NCLEX really does test your ability to take care of patients...SAFELY. That's the thing I had always missed. I have been teaching nursing since I got my MSN, so I have prepared hundreds of students to take the NCLEX, and never once did I realize that the NCLEX only tests ONE CONSTRUCT. I am not sure how I missed that important detail, but now in my role as a patient safety specialist, I am more focused on patient safety and it makes total sense to me.


    Every single question on the NCLEX is focused on patient safety. If you don't know the answer, you can simply ask yourself, if I only do one of the things on this list of answer options, which one is the safest for my patient? You can ask questions several ways to help you choose the right answer - here are some of my favorites:

    1. Which of these patients will DIE if I don't see them?
    2. Will this kill my patient?
    3. If I can only do one thing and then leave the building and go home, which thing will it be?
    4. Am I doing something that might harm my patient? When in doubt choose the answer that doesn't include any risk of harm.

    A few other key strategies:

    1. Always ask yourself what a nursing textbook would say - don't rely on your experience.
    2. Know your content: memorize lab values, know your blood gasses, common drug side effects (antibiotics, pain meds, antipsychotics, INSULIN!), review common procedures and make sure you know timing (suctioning for example) and proper technique.
    3. You can answer many questions without knowing content if you focus on patient safety, Maslow, ABCs and ADPIE, but some of them absolutely require a knowledge of nursing content - so crack open that fundamentals book again.
    4. It's not always AIRWAY! Ask yourself if the answer makes sense. The NCLEX test writers try to distract you on purpose- they are looking for your ability to use nursing process to make safe decisions.

    What is even more exciting to me is the realization that the test-taking strategies students learn in NCLEX test prep courses can be used on the job. If it applies to NCLEX, then it applies to patient safety. You are learning tools to improve your patient's safety, and reduce the risk that you will make an error - something every new nurse is afraid of. You really can't go wrong taking one of these courses. In addition, if you choose a good one - they will give you many tools for reducing your test anxiety - which many of you know is more than half the battle. Anxiety gets in the way of your ability to pull out those deeply buried Lithium toxicity levels (know those!) You can find so much great info on the NCLEX on the National Council of State Boards of Nursing website - if you haven't been there yet, GO!

    Understanding the NCLEX will reduce your anxiety and increase the likelihood that you will pass. Read the FAQs, and watch a few videos - they explain SO WELL what it takes to pass.

    Here is a link to the NCSBN webpage that discusses the nature of Computer Adaptive Testing: Computerized Adaptive Testing (CAT) | NCSBN
    Spending 5 minutes on this link alone will make your test experience so much less traumatic, and increase your chances of success!

    Good luck to those of you who are preparing to take the NCLEX - not that you will need any luck - the NCLEX is a test of minimum competency, and if you have graduated from a nursing school - you have minimum competency. YOU CAN DO IT!
    Last edit by Joe V on Jun 14
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    About SafetyNurse1968, PhD, RN

    Kristi Miller, also known as Safety Nurse, just got her Doctorate in nursing! She is a patient safety specialist with a blog and podcast on patient safety topics (check out and Safety Rules on iTunes or Stitcher). She is raising 4 kids, a garden, a husband, 2 guinea pigs, 2 dogs and a cat, while sending out daily cover letters and CVs – hoping for a teaching gig that will keep her in the mountains of Western North Carolina.

    Joined: Jun '11; Posts: 142; Likes: 371
    Nurse Entrepreneur; from NC , US
    Specialty: Oncology, Home Health, Patient Safety

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  3. by   VCstudent
    I loved how thought out and well written this article was and cherish this insight. Thank you for your experience!
  4. by   Lovens9
    Thank you so much ! very helpful
  5. by   SafetyNurse1968
    Quote from VCstudent
    I loved how thought out and well written this article was and cherish this insight. Thank you for your experience!
    You are so welcome! Thanks for reading.