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You’ve made it through the two or four-year program.  You can no longer count the all-nighters and the total hours of study, and that’s only been the last week in preparation for the final.  But you made it to the pinning.  You looked around at your classmates.  You stand in your white scrubs thinking of those who didn’t make it here, either they failed out or quit.  A relief, a hefty amount of stress is lifted off your shoulders.  Days later, maybe even a full week after pinning it dawns on you, you need to know all of it and take a randomized test.  Is it going to be all pharm?  Is it going to all maternity?  Then that fear develops in the pit of your stomach.

A quick review of what the NCLEX is for anyone who does not know.  The NCLEX, the National Council Licensure Exam, is a national exam given to those who have passed an accredited nursing program.  The test is proctored on a computerized adaptive testing format, which means if you get a question correct, you are then the next one given is even harder.  This way allows the exam to analysis the complexity of your knowledge.  There is a minimum of sixty actual and fifteen practice or test questions, the session could run from seventy-five to two-hundred-sixty-five questions.  The exam does not give you a grade at the end, you either pass or fail.  The items are on three levels: below passing, at passing, and above the crossing.  For example, you start out with your first question, if you get it wrong, the next question will be slightly more straightforward.   A certain percentage of test items answered in the below passing area will be determined a fail.  If the problem is correct, then you get a harder question.  This is how you can climb out of the failing area and go back into the passing zone or stay within the passing zone.  The test content includes Safe and Effective Care Environment Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, Physiological Integrity Basic Care, and Comfort, Pharmacological and Parenteral Therapies Reduction of Risk Potential and Physiological Adaptation.  These questions cover the content in Medical/Surgical, Pediatrics, Maternity, and Mental health.  More information found at NCSBN.org.

Now that you’ve graduated your stomach has had a week break from school, and you are now knowledgeable on what the exam is about, it’s time to study.

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#1 Take a Prep-Course

There are so many prep courses.  I considered several of them; the top four were Kaplan, Hurst, UWorld, and ATI.  I ended up using a bit from all four but spent the big bucks on the Hurst Review.  The pre-course will not only go over everything in a nice clean and timely fashion since it would be well over a year since seeing anything about HELLP, (hemolysis, elevated liver enzymes, low platelet count).  The review went over everything and concepts were delivered in a different light.   There were some concepts that I had trouble fully comprehending then presented through the study I understood better.  Not to mention the evaluated questions and rationales.

#2 Evaluate your weakness and strength

The best way to do this is by taking either an evaluation exam or a practice exam found near the back of a Saunders or Lippincott book.  A review course will usually do an automatic one at the end of the program to provide more question.  These exams will go through a good sampling of content and different types of items.  Keep in mind to pay attention to not only the clinical content area but also client need categories.  ATI, Lippincott, and Saunders will go through the rationales, and they tell you which patient care area of the question.  I realized that a particular patient care area I would consistently get wrong regardless of the clinical area, I realized the wording and question structure then understood how to answer these items.  Knowing your weakness and strength will allow you to focus your study time in a direction that is more productive and valuable.

#3 Make a schedule…and stick to it.

If you already know the date of your exam and you’re on a timer plan.  Realistically, how much time are you reasonably able to study.  The test is the most important one, and although you can take it as many times a needed, I only wanted to dish out $200 once.  Put aside time every day or five times a week.  Keep in mind other responsibilities like work, family, friends, kids, also consider your own retention time.  If you can only study an hour before needing a break, more frequent short sessions may be better for you, not everyone is able to review the same.    I personally can only study a maximum of two hours before my eyes can no longer differentiate the words.  I knew of some classmates with a higher level of stamina and would study four to six hours straight.  Knowing your content weakness, I would make them your priority.  I studied maternity the most.  Labor and delivery were more than a year ago, and the lectures were interrupted by a series of snowstorms.  Our classes were always Monday and Tuesday; we were nearly halfway through the semester when we got our first full week of lectures and clinical.  The professors were forced to post voiced over PowerPoints presentation.  I never thought I would have ever gotten tired of snow days.  Have an objective or agenda before sitting down to study, this will make for more productive and efficient use of time.  It’s more comfortable to sit down with material for disease and divide the time into the cause, symptom, and nursing consideration when you have the right book and a direct focus.

#4 Questions, Questions, Questions!

Reviewing the material is just the beginning of preparing, you also want to answer every question you can find.  The reviews will have some question samples and a few full exams with sixty or more items.   If you are having trouble or guessing an answer mark the question, so later you could review why you were having trouble.   Most reviews have rationales.  I would love to say read through all of them, but even if you are answering a hundred questions a day, you’re looking at four-hundred statements.  Mark the ones you don’t feel confident in, also if you get the question correct.  The more you can assess why you are not sure about a problem will help you to remedy the situation.  Reviewing the content, understanding how to read the information in the question, and understanding what the question is asking you, will drastically help in finding the correct answer.

#5 Learning some tricks when you don’t know the answer

No matter how long you study or how confident you feel, there is still a chance of getting a question you have no idea what they are even talking about.  There are some tricks for when you don’t have any idea. Not every question can be answered 100% correctly.  If two answers are opposite one is the answer, eliminate the two possibilities.  If one solution repeats the question verbatim, it might be the answer.  Remember ABCs, no absolutes, and mental health questions always bring it back to the patient or client.

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Check out these 4 Tips for the morning of the NCLEX & 4 Tips when preparing the night before the NCLEX