Summary test plan

Test plan final
Table of Contents

I. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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II. 2023 NCLEX-RN® Test Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Classification of Cognitive Levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Test Plan Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
 Client Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
 Integrated Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
 Clinical Judgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Distribution of Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Overview of Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Safe and Effective Care Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
 Management of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
 Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Health Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Physiological Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
 Basic Care and Comfort. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
 Pharmacological and Parenteral Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
 Reduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
 Physiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
III. Administration of the NCLEX-RN® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Examination Length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
The Passing Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Similar Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Reviewing Answers and Guessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Scoring the NCLEX® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
 Computerized Adaptive Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
 Pretest Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
 Passing and Failing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
 Scoring Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
 Types of Items on the NCLEX-RN® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

,ii 2023 NCLEX-RN® Test Plan


 NCLEX® Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
 Examination Security and Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
 Tutorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Appendix A
Sample Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Safe and Effective Care Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
 Management of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
 Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Health Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Physiological Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
 Basic Care and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
 Pharmacological and Parenteral Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
 Reduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
 Physiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Appendix B
Item Writing Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Appendix C
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54




National Council of State Boards of Nursing, Inc. (NCSBN) | 2023

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I. Background
The test plan for the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) was developed by the
National Council of State Boards of Nursing, Inc. (NCSBN®). The purpose of this document is to provide detailed information
about the content areas tested in the NCLEX-RN Examination.


This booklet contains:
 The 2023 NCLEX-RN® Test Plan;

 Information on testing requirements and sample examination questions (items); 
Item writing tips; and  References.




About the NCLEX-RN® Test Plan
The test plan is reviewed and approved by the NCLEX® Examination Committee (NEC) every three years. Multiple
resources are used, including the recent practice analysis of registered nurses (RNs) and expert opinions of the NEC,
NCSBN staff and boards of nursing/regulatory bodies, to ensure that the test plan is consistent with nurse practice acts.
Following the endorsement of proposed revisions by the NEC, the test plan document is presented for approval to the
Delegate Assembly, which is the decision-making body of NCSBN.
The test plan serves a variety of purposes. It is used to guide candidates preparing for the examination, to direct item writers
in the development of items and to facilitate the classification of examination items. This document offers a comprehensive
listing of content for each Client Needs category and subcategory outlined in the test plan. Sample items are provided at the
end of each category that are specific to the Client Needs category in that section. There are item writing tips that provide
nurse educators with guidelines on writing well-designed test items.


For up-to-date information on the NCLEX-RN Examination, visit the NCSBN website at NCLEX.com.
II. 2023 NCLEX-RN® Test Plan

Test Plan for the National Council Licensure Examination for Registered Nurses ( NCLEX-RN® )

Introduction
Entry into the practice of nursing is regulated by the licensing authorities within each of the National Council of State Boards
of Nursing (NCSBN®) member board jurisdictions (state, commonwealth, province and territorial boards of nursing). To
ensure public protection, each jurisdiction requires candidates for licensure to meet set requirements that include passing
an examination that measures the competencies needed to perform safely and effectively as a newly licensed, entry-level
registered nurse (RN). NCSBN develops a licensure examination, the National Council Licensure Examination for Registered
Nurses (NCLEX-RN®), which is used by member board jurisdictions and most Canadian nursing regulatory bodies, to assist in
making licensure decisions.
Several steps occur in the development of the NCLEX-RN Test Plan. The first step is conducting a practice analysis that is used
to collect data on the current practice of the entry-level nurse (Report of Findings from the 2021 RN Practice Analysis:
Linking the NCLEX-RN® Examination to Practice [NCSBN®, 2022]). Twentyfour thousand newly licensed RNs are asked about
the frequency, importance and clinical judgment relevancy of performing nursing care activities. Nursing care activities are
then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings
where the activities are performed. This analysis guides the development of a framework for entry-level nursing practice
that incorporates specific client needs as well as processes fundamental to the practice of nursing. Clinical judgment is one
of the fundamental processes found to possess a high level of relevance and importance in the delivery of safe, effective
nursing at the entry level.



National Council of State Boards of Nursing, Inc. (NCSBN) | 2023

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Entry-level nurses are required to make increasingly complex decisions while delivering client care. These increasingly
complex decisions often require the use of clinical judgment to support client safety. It is essential to note that clinical
judgment applied in this dynamic supports the entry-level nurse to make effective decisions inside the nursing scope of
practice, which provides a foundation for client safety. NCSBN has conducted several years of research and study to
understand and isolate the individual factors that contribute to the process of nursing clinical judgment. These isolated
factors are represented in the NCLEX-RN Test Plan and subsequently delivered as examination items. A more detailed
description of clinical judgment can be found in the Integrated Processes section.
The second step is the development of the NCLEX-RN Test Plan, which guides the selection of content and behaviors to be
tested. The NCLEX-RN Test Plan provides a concise summary of the content and scope of the licensing examination. It serves
as a guide for examination development as well as candidate preparation. The NCLEX® assesses the knowledge, skills,
abilities and clinical judgment that are essential for the entrylevel nurse to use in order to meet the needs of clients
requiring the promotion, maintenance or restoration of health. The following sections describe beliefs about people and
nursing that are integral to the examination, cognitive abilities that will be tested in the examination and specific
components of the NCLEX-RN Test Plan.

Beliefs
Beliefs about people and nursing underlie the NCLEX-RN Test Plan. People are finite beings with varying capacities to
function in society. They are unique individuals who have defined systems of daily living reflecting their values, motives and
lifestyles. People have the right to make decisions regarding their health care needs and to participate in meeting those
needs. The profession of nursing makes a unique contribution in helping clients (individual, family or group) achieve an
optimal level of health in a variety of settings. For the purposes of the NCLEX, a client is defined as the individual, family, or
group, which includes significant others and population.
Nursing is both an art and a science, founded on a professional body of knowledge that integrates concepts from the liberal
arts and the biological, physical, psychological and social sciences. It is a learned profession based on knowledge of the
human condition across the life span and the relationships of an individual with others and within the environment. Nursing
is a dynamic, continuously evolving discipline that employs critical thinking and clinical judgment to integrate increasingly
complex knowledge, skills, technologies and client care activities into evidence-based nursing practice. The goal of nursing
for client care is preventing illness and potential complications; protecting, promoting, restoring and facilitating comfort;
health; and dignity in dying.
The RN provides a unique, comprehensive assessment of the health status of the client, applying principles of ethics, client
safety, health promotion and the nursing process. The RN then develops and implements an explicit plan of care
considering unique cultural and spiritual client preferences, the applicable standard of care and legal considerations. The
RN assists clients to promote health, cope with health problems, adapt to and/or recover from the effects of disease or
injury, and support the right to a dignified death. The RN is accountable for abiding by all applicable member board
jurisdiction statutes related to nursing practice.

Classification of Cognitive Levels
Bloom’s taxonomy for the cognitive domain is used as a basis for writing and coding items for the examination (Bloom, et al.,
1956; Anderson & Krathwohl, 2001). Since the practice of nursing requires application of knowledge, skills, abilities and
clinical judgment, the majority of items are written at the application or higher levels of cognitive ability, which require more
complex thought processing.

Test Plan Structure
The framework of Client Needs was selected for the examination because it provides a universal structure for defining
nursing actions and competencies and focuses on clients in all settings.

Client Needs
The content of the NCLEX-RN Test Plan is organized into four major Client Needs categories. Two of the four
categories are divided into subcategories. Safe and Effective Care Environment



National Council of State Boards of Nursing, Inc. (NCSBN) | 2023