Study Techniques and Learning Strategies / 01
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Elaine Ellibee, who served as the President of the National Council of State Boards of Nursing (NCSBN) from 1978 to 1979, once expressed:
These ideas form the foundation of one of the most significant board evaluations worldwide, specifically for Registered Nurses in the United States and now globally.
Having reviewed various study techniques in the previous module, it is time to learn more about the NextGen NCLEX, understanding its structure, the question types you will encounter during the exam, and some open sources that can help reinforce your knowledge and prepare for the NCLEX. Notable, in April 2023, the NCSBN introduced some changes to the format of the exam questions. Therefore, this module is essential in identifying these changes and being prepared for them.
Remember that excelling in the NCLEX exam requires practice and familiarity. The more you know about the exam, the higher your chances of passing will be.
Before starting your NCLEX study journey, it is crucial to understand the format of the exam. The NCLEX exam uses a CAT format, which means computerized adaptive testing therefore (CAT). This approach ensures that there are not two identical exams, offering a dynamic and personalized testing experience for each nurse candidate (Anderson et al., 2001; Bloom et al., 1956).
In the CAT format, the question difficulty is adjusted in real-time based on the candidate's performance. As you progress through the exam, the computer adjusts the next type of questions to your individual ability level. If you answer a question correctly, the subsequent question might be more challenging/difficult, testing your knowledge. Conversely, if you answer incorrectly, the following question might be easier.
Lastly, do not forget that to succeed your NCLEX exam, you will need to focus on constructing a solid foundation about different nursing topics. Practice with sample questions available in different websites freely to become familiar with the adaptive testing type of exam. Additionally, enhancing your critical thinking skills and time management will be beneficial for you to excel in the exam.
2.1 Introduction to NCLEX Exam
Before delving into the details of the NCLEX Exam, it is essential to familiarize yourself with the organization that oversees and regulates it, known as the National Council of State Boards of Nursing or NCSBN. The NCSBN is an independent non-profit organization in the United States that coordinates the nursing regulatory bodies from 50 states, the District of Columbia, and four U.S. territories (NCSBN, n.d.-a). Its primary mission and responsibility, as stated in the Mission Statement Adopted by Delegate Assembly in 2019, lie in upholding “regulatory excellence for public health, safety, and welfare, and to protect the public by ensuring that safe and competent nursing care is provided by licensed nurses” (NCSBN, n.d.-a, History section).
2.2 NCLEX Structure and Scoring Scale
NCLEX overview:
The National Council Licensure Examination (NCLEX) is a pivotal milestone for aspiring nurses seeking licensure in the United States and Canada. It is a computerized adaptive test (CAT) that gauges the knowledge and critical thinking abilities of candidates to determine their readiness for safe and effective nursing practice. The NCLEX is offered in two formats: NCLEX-RN for those aspiring to become Registered Nurses (RNs) and NCLEX-PN for those pursuing licensure as Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs). The exam's unique CAT format tailors the difficulty of questions based on the candidate's performance, providing a personalized testing experience. All registered nurse (RN) candidates must answer a minimum of 85 items. The maximum number of items that an RN candidate may answer is 150 during the allotted five-hour period. Of the minimum-length examination, 52 of the items will come from the eight content areas listed above in the stated percentages. The NCLEX covers four major content areas:
Please refer to: “RN Test Plan,” 2023 at https://www.ncsbn.org/public-files/2023_RN_Test%20Plan_English_FINAL.pdf for more information.
Table 1
Content Distribution
At the beginning of 2023, the National Council of State Boards of Nursing (NCSBN) announced the Next Generation NCLEX (NGN) project as a cutting-edge effort to improve the National Council Licensure Examination (NCLEX). The NGN initiative was created to modernize the evaluation of nursing competency, its goal is to include more improved clinical judgment measurement and link the exam with current nursing practice. The NGN project aims to develop the next generation of nursing professionals and raise the nursing practice standards to meet the changing demands of healthcare systems around the world by redesigning the examination format and scoring methodology (NCSBN, n.d.-b).
Based on the findings from the special research section, the NCSBN has recently approved the inclusion of five new types of questions designed to assess nursing clinical judgment on the Next Generation NCLEX (NGN). While the NCSBN acknowledges that these new questions might be challenging for those students who are less technological experienced, they firmly believe that these innovations will lead to a more accurate evaluation of students' clinical and professional skills (Morris, 2023).
Below are the key changes introduced, along with a brief description of the five different types of questions plus the new type of questions named Case Study Questions (RegisteredNurseRN.com, n.d.-b):
Figure 1
Example of an Extended Multiple Response Question
Retrieved from NCSBN. (2019, p. 2). Approved NGN Item Types. https://www.ncsbn.org/public-files/NGN_Fall19_ENG_final.pdf
Candidates taking the NCLEX must carefully evaluate each option in the context of the patient scenario to identify all appropriate interventions for safe and effective care.
Figure 2
Example of an Extended Drag and Drop Question
Retrieved from NCSBN. (2019, p. 2). Approved NGN Item Types. https://www.ncsbn.org/public-files/NGN_Fall19_ENG_final.pdf
Figure 3
Example of an Extended Drag and Drop Question
Retrieved from NCSBN. (2019, p. 3). Approved NGN Item Types. https://www.ncsbn.org/public-files/NGN_Fall19_ENG_final.pdf
To excel in Drag and Drop questions on the NCLEX, it is essential to practice with sample questions of this type and become familiar with the user interface. By improving your ability to manage and manipulate information through this interactive format, you will be well-prepared to tackle these questions with confidence and efficiency on the actual exam.
Figure 4
Example of a Matrix/Grid Question
Retrieved from NCSBN. (2019, p. 4). Approved NGN Item Types. https://www.ncsbn.org/public-files/NGN_Fall19_ENG_final.pdf
Practice with sample matrix/grid questions and familiarization with this question structure are crucial for success on matrix/grid questions on the NCLEX. Candidates can approach matrix/grid questions on the actual NCLEX exam with confidence and accuracy by honing their ability to navigate and analyze complicated data provided in a table format.
Figure 5
Example of an Enhanced Hot Spot Question
Retrieved from NCSBN. (2019, p. 3). Approved NGN Item Types. https://www.ncsbn.org/public-files/NGN_Fall19_ENG_final.pdf
Case Study Questions:
As mentioned before, in April of 2023, the NCSBN released a new version of the NCLEX exam, which is called the Next Generation NCLEX (or NGN). One of the big changes with the Next Generation NCLEX was the introduction of case studies (NCSBN, n.d.-b).
The Next Generation NCLEX (NGN) exam brings forth significant changes, notably a prominent shift toward incorporating case studies. Emphasizing a deeper level of critical thinking, these case study questions demand a comprehensive understanding of diseases, particularly their underlying pathophysiology. By delving into the intricacies of the patient's condition and medical history, candidates must apply their knowledge to make well-informed nursing decisions. Effectively addressing case study questions requires candidates to analyze clinical data, interpret diagnostic results, and identify appropriate nursing interventions based on the patient's unique needs (RegisteredNurseRN.com, n.d.-b).
Practicing with case study questions during NCLEX preparation is essential to develop the ability to think critically and apply nursing knowledge in realistic patient care scenarios. It allows candidates to gain confidence in their clinical judgment skills and prepares them for the challenges they may encounter in their nursing careers (RegisteredNurseRN.com, n.d.-b).
Types of Scoring for the NCLEX Exam:
The Next Generation NCLEX is introducing changes to its scoring model. The new scoring system will be a polytomous scoring model, offering candidates the opportunity to receive partial credit on certain questions with multiple inputs. This marks a departure from the previous NCLEX model, which only provided "full credit" or "no credit" for each question.
The polytomous scoring model will be applied to various question types, including the dreaded "select all that apply" (SATA) questions. This means that candidates will have the chance to earn credit for correctly selecting some of the multiple correct answers in SATA questions, even if they don't select all of them.
The Next Generation NCLEX will implement three distinct scoring models, each tailored to different question types according to the NCSBN (n.d.-b).
0/1 Scoring Model:
In the 0/1 scoring system, you are awarded one point for every correct option selected, while selecting an incorrect option yields zero points. The individual points for each correct response are then tallied to arrive at the total question score. This scoring method is applied to various question types, including multiple-choice, matrix multiple-choice, multiple response (where you select a specified number of answers - "select N"), drop-down cloze, drop-down table, and bowtie questions.
In essence, the 0/1 scoring system simplifies the evaluation process, making it easier to measure your performance on these question formats. By earning points for each correct answer, it encourages precise and accurate responses, while incorrect choices carry no penalty.
Understanding the scoring system for each question type is crucial as you prepare for the exam. Practicing with sample questions utilizing the 0/1 scoring system can help you familiarize yourself with the process and develop effective strategies to approach these question formats with confidence and precision. By mastering this scoring method, you can optimize your performance and increase your readiness for the Next Generation NCLEX (NCSBN, n.d.-c; RegisteredNurseRN.com, n.d.-a).
Figure 6
0/1 Scoring Model
Retrieved from RegisteredNurseRN.com. (n.d.-d). Matrix Scoring NCLEX. https://www.registerednursern.com/wp-content/uploads/2022/08/matrix-scoring-nclex.png
+/- Scoring Model:
The accuracy of your responses will determine whether points are added or subtracted under the +/- scoring system. Each well-chosen option entitles you to one point, demonstrating your aptitude for determining the correct responses. To emphasize the importance of accuracy in your selections, it is crucial to know that choosing the erroneous option results in a point deduction. Select all that apply (SATA), multiple-response questions, matrix multiple-response questions, and MR (Multiple Response) grouping questions are all specifically used with this scoring approach (RegisteredNurseRN.com, n.d.-a; NCSBN, n.d.-b).
The exam evaluates your ability to recognize accurate responses as well as your alertness in avoiding incorrect selections using the +/- score system. This strategy highlights the value of critical thinking and thorough analysis during the exam, as both accurate and incorrect answers have an impact on your final grade (RegisteredNurseRN.com, n.d.-a; NCSBN, n.d.-b).
Figure 7
+/- Scoring Model
Retrieved from RegisteredNurseRN.com. (n.d.-c). Extended Multiple Response Scoring NCLEX. https://www.registerednursern.com/wp-content/uploads/2022/08/matrix-scoring-nclex.png
Rationale Scoring:
Rationale scoring is a unique approach where points are awarded solely when you demonstrate a proper understanding of the underlying reasoning behind the question. In this format, your responses will involve selecting paired options that logically follow one another, such as in the example "A leads to B." To earn a point, both options within the pair must be correctly selected.
This scoring method challenges you to not only identify correct answers but also to comprehend the cause-and-effect relationship or logical sequence presented in the question. It encourages you to think in a critical and analytical way, to ensure that your responses are based on a comprehensive understanding of the concepts being assessed.
In the Next Generation NCLEX, mastering rationale scoring is essential, as it emphasizes your ability to apply knowledge in a meaningful and contextually relevant manner. By focusing on the rationale behind each question, you can confidently navigate this scoring format, earning points for responses that demonstrate your sound reasoning and logical deductions.
As you prepare for the exam, practice with sample questions that incorporate rationale scoring, refining your skills in identifying interconnected concepts and justifying your choices. By excelling in this scoring method, you enhance your readiness to tackle complex scenarios and achieve success on the Next Generation NCLEX (NCSBN, n.d.-b; RegisteredNurseRN.com, n.d.-a).
Figure 8
Rationale Scoring
Retrieved from Registered Nurse RN.com. (n.d.-e). Rationale NCLEX Question. https://www.registerednursern.com/wp-content/uploads/2022/08/matrix-scoring-nclex.png
During the Next Generation NCLEX exam, each candidate will face a variable number of questions, with a minimum of 85 and a maximum of 150. However, it's important to note that out of these, 15 questions are pretest questions that do not contribute to the final score. Consequently, candidates can anticipate encountering between 70 to 135 questions that are scored on the exam. The exam will continue until the computer reaches 95% confidence in its determination of whether the test taker has passed or failed (This is called the 95% confidence interval rule). Additionally, the test may conclude if the allotted time of 5 hours expires or if the candidate reaches the maximum number of questions (135). To ensure sufficient time for thoughtful responses, candidates are granted a total of 5 hours to complete the Next Generation NCLEX exam (NCSBN, n.d.-b).
2.3 NCLEX Resource Guide
NCLEX preparation begins with establishing a timeline and a clear goal: when would you like to take the NCLEX? While there may not be a specific timeline that suits every student, we can certainly reach a consensus that studying too late or starting to review the materials only a few months before taking the NCLEX will lead to frustration and a poor understanding of the new format and questions.
There are many resources available, including flashcards and expensive textbooks. However, it is important not to overwhelm yourself with a variety of materials, as it might be unlikely to find time to go through all of them thoroughly. We recommend getting a textbook and a "strategy" book. The "strategy" book can be a review of test-taking strategies or a comprehensive review of different question formats, complete with many examples to simulate the real exam environment.
Depending on your study goals, you might be able to maximize your NCLEX preparation by making a precise schedule to study and focusing on all the study resources available. Investing enough time in learning, practicing, and reviewing can help you build a strong knowledge foundation and improve your critical thinking skills, all of which are necessary for exam performance.
The NCLEX evaluates your ability to apply your nursing skills in real-world circumstances in addition to measuring your nursing knowledge.
Here you can find some resources that might help you preparing for the NCLEX exam:
When it comes to practice questions, we highly suggest that students engage in regular practice answering an average of 60-90 questions at least twice a week. Consistent practice is crucial to building confidence and familiarity with the question-and-answer formats, especially considering the new changes on the NCLEX Next Generation.
For your convenience, we suggest utilizing the following questions banks, which will be accessible when you begin your next micro credential. Creating a dedicated calendar is an essential step to track your progress. Mark down the number of questions you answer daily, as this will aid in identifying your weaker subjects. By pinpointing areas that require more attention, you can develop a focused and effective studying strategy.
Remember, practice makes perfect, and the more you immerse yourself in answering questions, the better prepared you will be to excel on the NCLEX exam. Stay focused, and trust in your abilities as you work towards achieving your goal of becoming a licensed registered nurse. The following links are some main question banks:
https://nursing.uworld.com/nclex-rn/
https://nursing.com/product/simclex
https://www.nclex.com/prepare.page
(As a free and open resource, we highly recommend taking all of these questions before starting a study calendar or delving into study materials.)
The NCLEX exam signifies the culmination of your journey to become a skilled and compassionate nurse. Embrace the challenge with confidence and trust in your preparation. Each question is an opportunity to showcase your critical thinking and clinical knowledge.
Remember, you are not alone on this journey. Countless nurses have succeeded before you, inspiring future generations, including yourself.
To improve your performance and achieve success in the NCLEX exam, please consider the following strategies:
By adhering to these guidelines, you can optimize your preparation and increase your chances of performing well on the NCLEX exam.
Believe in your abilities, stay focused, and let your passion for nursing guide you. Embrace this opportunity to become a competent and caring nurse, prepared to face the challenges and joys of this noble profession. Your path to excellence begins now.
As the NCLEX operates on a pass/fail basis, immediate access to your graded results isn't available. Instead, your state board of nursing will receive your Overall Passing Score (OPS). Nonetheless, comprehending the scoring mechanisms of the exam can offer valuable insights into your performance during the test.
The exam follows a computer-adaptive format that employs algorithms to determine your score. Several rules are employed by the computer to determine your pass or fail status:
Given these considerations, it's advisable to prepare for the possibility of encountering the maximum number of questions. During practice tests, aim to respond to between 100 and 145 questions while adhering to the time constraints.
To enhance your test-taking experience, consider the following suggestions:
In conclusion, the NCLEX exam is a crucial milestone for aspiring nurses, testing their competence and readiness to practice safely and effectively. The exam's structure includes various question formats, and Computerized Adaptive Testing (CAT) tailors difficulty based on responses. Scoring methods demand precision and critical thinking. Adequate preparation and understanding of question types are vital for success. Good luck!
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