The NCLEX test uses a computer adaptive format, which means that the next question will change depending on how well you answer the previous question. A correct answer on one question means the next question will be more advanced, while a wrong answer means the following question will be at a lower level of skill. You must answer enough questions at a high level to show you have mastered the material, so the better you do, the fewer questions you will have to answer. The computer program will keep asking questions until you have demonstrated your competency, or a lack of competency, or until the time limit is reached. This will take between 75 and 265 questions. The test is graded as either pass or fail.
You will not be tested on any general academic skills, such as math or grammar. All the subject matter will cover one or more of four areas of nursing management and knowledge. Questions will cover provision of a safe and effective care environment, including infection control; ways to promote good health; psychosocial integrity of the patient; and physiological integrity of the patient, including basic care issues, pharmacological treatments and diagnostic tests. Knowledge of medical terminology and abbreviations is also very important, as these will be used in most questions.
Look for words that establish priority, such as "first" or "initial". Understand the rules of management and patient priority. Keep in mind normal ranges for lab and test results -- this will help you to decide if the patient has a problem or not. Always assess the patient before you implement a nursing action. There are no trick questions; you can assume you have a doctor's orders and that the answer is not to contact the doctor immediately. Keep patient safety in mind at all times and make sure you know the five rights of medication very well. Above all, stay calm.
Work out a study plan that will prepare you to take the test within six months of graduating. After that time, your skills and knowledge will start to get rusty. Make sure you understand the types of questions you will be asked and the strategy you will use for answering them. You may want to use a professional study guide and take an NCLEX test preparation course. Use flash cards and timed practice tests, and be sure to study regularly.