Priority Levels of NCLEX Questions

The NCLEX (National Council Licensure Examination) is a test taken by graduate nurses. They need to pass the test to earn state licenses to practice as either a licensed practical nurse or a registered nurse. The student must have graduated from an accredited nursing program in order to be eligible to sit the examination. If the student passes the test, she is awarded with a license to practice--or work as a nurse--for a period of time, after which the license must be renewed.

Candidates who do not pass the test must wait a period of 45 or 90 days to repeat the examination. The time is determined by the state's board of nursing. They must pay another testing fee, which is $200 as of 2011.

There are two different examinations offered: the NCLEX-PN and the NCLEX-RN. After the student graduates from a practical nursing program, he is eligible to take the NCLEX-PN test to become a licensed practical nurse. Students enrolled in the degree-level program are eligible to take the NCLEX-RN examination upon graduation, and will be licensed as Registered Nurses. Though the tests a similar in format, the NCLEX-RN is more difficult and the rate of failures is higher.

Graduates do not have to take the NCLEX-PN and may simply wait until they are eligible for the NCLEX-RN. However, they cannot be employed as nurses in any capacity until one of the licenses are obtained.

The NCLEX is an adaptive test, which means the test questions change to provide a testing experience tailored to the cognitive level of the individual being tested. For this reason, all exams are different. This prevents cheating.

To begin, the computer chooses what is considered to be a medium-difficulty question from the pool of thousands of questions. If the student answers that question correctly, another question is chosen from the pool that is slightly more difficult. If the question is answered incorrectly, a less difficult question is then presented to the tester. The test computer continues to offer questions within these parameters until it determines the candidate's level of comprehension. If the level of comprehension is at or above the passing standard, the candidate passes the test.

In CAT, the computer continues to offer questions until it has determined a level of comprehension, which means there are no standard number of questions. There is a minimum and a maximum number of questions. The number of questions received is not an indicator of success or failure.

NCLEX-PN candidates are tested on such subjects as safety and effectiveness in the nursing environment, care coordination, health promotion, infection control, psychosocial integrity, basic nursing care, pharmacology and psychiatric issues.

NCLEX-RN candidates are tested on the same subjects with increased difficulty. The questions may also involve questions about delegation and supervision of subordinate staff because the registered nurse may be put in a position of supervising others. The majority of NCLEX questions are multiple choice. Some questions are not scored and are for development purposes only.

The number of questions received is not an indicator of success or failure. A candidate who received the minimum number of questions is not more likely to have passed than a candidate who received the maximum number of questions, or vice versa. Test questions are never beyond the nurse's scope of practice. No candidate receives a preselected number of questions. The test adapts to the candidate's comprehension level. Priority questions--or those questions that ask the student what they should do first--are plentiful on the NCLEX examination, but they are not scored any differently than other questions.