United States / Canada / Australia · National Council of State Boards of Nursing (NCSBN), delivered at Pearson VUE centres · licensing · secondary source
Computerised adaptive testing (CAT). Between 75 and 145 questions. Up to five hours, including mandatory and optional breaks.
All US states and territories, ten Canadian provinces since 2015, and Australia since 2020. Several other countries accept an NCLEX-RN pass as part of their own registration route rather than as the examination itself. Adaptive: each question is selected based on how the candidate answered the previous ones.
Official source: https://en.wikipedia.org/wiki/National_Council_Licensure_Examination
The questions are the end-of-manual checks written with each SUNYRA nursing manual. An examination's practice paper draws on the subjects that examination's published blueprint covers; the questions were written to the subject, not to the examination's own pattern, and none is a past paper.
1. How should a patient's identity be confirmed before a procedure?
A. Ask them to state their own name and a second identifier
Asking whether somebody is Mr Singh invites a yes from a person who is unwell, hard of hearing or eager to co-operate. Open questions using two agreed identifiers are the standard, and bed numbers are not identifiers because patients move.
Clinical Skills and Procedures · End-of-manual check
2. A nurse is interrupted while drawing up an intravenous antibiotic. What is the safest action on returning to the task?
D. Restart the check sequence from the prescription
An interruption empties working memory, so the step a nurse believes they reached is not reliably the step they actually reached — which is how doses get repeated or components omitted. Resuming from memory relies on exactly the faculty that was just disrupted. A colleague cannot know the step either. Checking afterwards cannot detect a component already added twice.
Medication Administration and Safety · End-of-manual check
3. A nurse wears gloves to reposition a patient, removes them, and moves directly to the next bed. Which precaution has been missed?
D. Hand hygiene after glove removal
Hands are contaminated during glove removal and gloves can be perforated without the wearer noticing, so hand hygiene is required after every removal. Gloves reduce contamination; they never replace decontamination, and the belief that they do is one of the most common causes of transmission on a ward.
Infection Prevention and Control · End-of-manual check
4. Which definition of shock is most useful at the bedside?
A. Circulation failing to deliver enough oxygen for the tissues' needs
Blood pressure can remain normal in a patient who is already seriously compromised, because compensation holds it up. Defining shock as inadequate oxygen delivery rather than as a number is what allows it to be recognised before the pressure falls.
Pathophysiology · End-of-manual check
5. Which observation is checked before giving a medicine that slows the heart?
C. The pulse, against the rate specified by the service
Services specify a rate below which the dose is withheld and the prescriber informed, which makes this one of the clearest cases of a nurse's assessment gating an administration. It is also one of the steps most often skipped when a round is running late.
Pharmacology · End-of-manual check
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