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A 68-year-old male with end-stage heart failure tells the nurse, "I don't want any heroic measures if my heart stops." The patient does not have an advance directive on file. Which action should the nurse take FIRST?
A 72-year-old patient with terminal cancer says, "I want to make sure my family knows not to put me on machines if I can't breathe on my own." The patient is alert and oriented with no advance directive on record. What should the nurse do first?
A 75-year-old female with advanced COPD states, "If my breathing gets worse and I can't breathe on my own, I don't want to be put on a ventilator." There is no advance directive documented. What is the nurse's priority action?
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Continue practicing for freeNational Council Licensure Examination — Registered Nurse is a CAT exam of 85–150 (computer-adaptive) questions over 5 hours (breaks included).
8 practice areas in the NCLEX-RN question bank, each with its own questions and analytics.
Every question in the bank is written in one of these formats.
The NCLEX-RN is the licensure examination every registered nurse in the United States must pass before practising, and it is also used by the Canadian provincial regulators and a handful of other jurisdictions. It is developed by the National Council of State Boards of Nursing (NCSBN) and delivered on computer at Pearson VUE test centers. Since April 2023 it has been the Next Generation NCLEX (NGN), which added unfolding case studies and new item types built around NCSBN's Clinical Judgment Measurement Model.
The exam is computer-adaptive. It selects each item based on how you answered the previous ones and ends anywhere between 85 and 150 items. Your ability estimate, once it stabilizes, decides pass or fail. No raw percentage is involved. That has two practical consequences. First, everyone is tested at the edge of their own ability, so the exam feels hard to strong and weak candidates alike. Second, the mix of content comes from the NCSBN test plan, whatever your program spent the most time on. The practice bank on this page is organized by the same eight Client Needs categories so that your preparation follows the plan's weighting.
Source: NCSBN NCLEX-RN Test Plan (current edition, revised by NCSBN every three years)
| Client needs category | Share of exam |
|---|---|
| Management of Care | 15–21% |
| Safety and Infection Control | 10–16% |
| Health Promotion and Maintenance | 6–12% |
| Psychosocial Integrity | 6–12% |
| Basic Care and Comfort | 6–12% |
| Pharmacological Therapies | 13–19% |
| Reduction of Risk Potential | 9–15% |
| Physiological Adaptation | 11–17% |
Percentages are the ranges NCSBN publishes. The midpoints sum to 100%. The category names above follow our question bank. NCSBN's full label for the pharmacology category is "Pharmacological and Parenteral Therapies". Management of Care and Safety and Infection Control together (the Safe and Effective Care Environment client need) are roughly a third of every exam. NCSBN revises the test plan on a three-year cycle, so confirm the edition in force on your test date.
The NCLEX-RN is pass/fail. Every item is calibrated for difficulty on a logit scale, and after each answer the computer re-estimates your ability. The exam ends under one of three rules: the 95% confidence rule (the computer is 95% certain your ability is clearly above or clearly below the passing standard, which can happen as early as item 85), the maximum-length rule (you reach 150 items and your final ability estimate decides), or the run-out-of-time rule (the 5 hours expire, in which case the final estimate decides if you have answered at least the minimum number of items, and you fail if you have not). The passing standard is set by the NCSBN Board of Directors and re-evaluated every three years.
Traditional items score 0 or 1. Next Generation items (the six-item case studies and standalone items such as matrix, drop-down cloze, highlight, and bow-tie) use polytomous scoring, which awards partial credit for partially correct responses under the +/-, 0/1, or rationale scoring rules. Select-all-that-apply items are therefore no longer simply right or wrong. The shortest possible exam is 85 items, of which 15 are unscored pretest items being calibrated for future exams. You cannot tell which items are pretest. Every exam includes three case studies of six items each. Each case study walks one patient through the six steps of the Clinical Judgment Measurement Model: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.
Your nursing program has already covered the content. What the NCLEX adds is clinical judgment under adaptive pressure, so the plan below spends its time on applying knowledge to prioritization and delegation and to unfolding cases. It assumes 15 to 20 hours a week for 10 weeks and front-loads the highest-weighted categories.
NCLEX-RN distractors are nursing actions that would be correct in some other moment. The writer offers the intervention you would perform after the assessment, the delegation that would be appropriate if the task were not one only a registered nurse can take, the response that attends to the family instead of the client, and the action that treats a finding you should have reported first. Management of Care alone is 15 to 21 percent of the exam, and most of its items turn on that kind of ordering. PassExams explains, on every question and every plan, why the option you chose looked right and what in the stem ranked the correct one above it, so a miss becomes a lesson in prioritization instead of a lost point.
On Pro each wrong option is labelled with its trap type (reading trick, rule swap, scope confusion, partial answer, true but not the best action), and the analytics collect those labels by Client Needs category. That is how you learn that your Pharmacological Therapies misses are recall gaps while your Management of Care misses are ordering errors, which are two problems with two different fixes. When you miss an item the variant engine rewrites it around a new client with a different set of vital signs, so the retry tests the judgment and not your memory of one scenario. Hints remove the most tempting distractor and point you at the cue you passed over. Case studies reward the same skill through all six steps of the clinical judgment model, so the aim is to think the way the item writer thinks and not to memorize more drug cards.
Work to the NCSBN test plan instead of your program's syllabus, and give the most time to Management of Care and Pharmacological Therapies, the two heaviest categories. Practise the six-item case studies as one continuous set of decisions about a single patient, because the cues you identify early drive the actions you take later. Select-all and matrix items carry partial credit, so weigh each option separately instead of counting how many look right. Rehearse at roughly 90 seconds per traditional item so that five hours, breaks included, never becomes the constraint.
Between 85 and 150. The exam is computer-adaptive and ends when it is 95% confident of your result, when you reach 150 items, or when time runs out. The minimum 85 items include 15 unscored pretest items.
Five hours. That includes the tutorial and two optional breaks. Break time counts against the five hours, so there is no advantage to skipping breaks other than the time itself.
There is no percentage score. The exam is pass/fail based on whether your estimated ability is above the passing standard, which NCSBN sets on a logit scale and reviews every three years. Practically, that means consistently answering above-average-difficulty items correctly. There is no fixed number of correct answers to reach.
By design it feels hard to everyone, because the adaptive algorithm keeps serving items near your ability. NCSBN publishes pass rates by candidate type. First-time, U.S.-educated candidates pass at a substantially higher rate than repeat candidates, and candidates who fail often report that prioritization and delegation questions cost them more than missing facts.
The version of the exam in use since April 1, 2023. It kept the eight Client Needs categories and the adaptive design but added three six-item case studies per exam and new item types (matrix, drop-down cloze, highlight, bow-tie, and trend) that are scored with partial credit and measure clinical judgment instead of recall.
No. The exam stops at 85 whenever the computer is 95% confident of the outcome in either direction. It also stops at 85 for candidates who are clearly below the standard. The only reliable signal is your official result from the board of nursing.
After 45 days, under NCSBN's policy, and no more than eight times in a 12-month period. Some boards of nursing set longer waits or fewer attempts. Use your Candidate Performance Report to target the categories where you were below the standard.
The run-out-of-time rule applies. If you have answered at least the minimum number of items, the computer uses your final ability estimate to decide pass or fail. If you have not reached the minimum, you fail regardless of performance, which is why pacing matters even on an adaptive exam.
Both are adaptive exams of 85 to 150 items in 5 hours, but they test different scopes of practice. The RN exam weights Management of Care (leading and delegating) while the PN exam weights Coordinated Care (contributing to a plan of care under supervision), and the two have separate passing standards. See our NCLEX-PN vs NCLEX-RN comparison for the full breakdown.
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