NCLEX Questions | NCLEX-RN Success:Evidence-Based Strategies

Evidence-based nursing requires that students think reflectively and use clinical inquiry to develop clinical reasoning and decision-making skills. Likewise, nursing students need a strategy to be successful in passing the NCLEX-RN. The authors identify strategies based on nursing research to facilitate student success.

While learning the evidence-based nursing process, the student must begin to think like a nurse while answering clinical practice questions. Using the skills taught for evidence-based nursing can be a powerful tool to approach the NCLEX-RN and succeed.

Evidence-based nursing (EBN) requires thinking reflectively and using clinical inquiry to answer clinical questions. For students to be successful in passing the NCLEX-RN, they must apply these same skills in multiple-choice (MC) tests. How can faculty members help students be successful test takers? What contributes to testing errors on MC tests? As Ireland stated, "evidence-based nursing[horizontal ellipsis] uses problem solving methods to integrate the best research evidence with client preferences, values, and clinician expertise.

Content Mastery

Standardized testing and achievement examinations create a foundation for the NCLEX-RN. Interventions that meet student needs and result in improved NCLEX-RN pass rates have been identified. Starting in the first semester, faculty members need to prepare students to succeed on computerized MC tests including alternative test item forms. Ireland recommended introducing EBN and the EBN process in the first semester. Students who used both strategic and deep learning approaches are more successful. Using the EBN process, the student can begin to reflect on practice and incrementally develop a tolerance for differing clinical perspectives, evolving from student to novice practitioner.

Test Anxiety

The academic implications of test anxiety are fears associated with failing examinations or the entire program. They found that effective measures of dealing with anxiety included endurance, self-control, and self-discovery measures of stress management. Students recognize the significance of the NCLEX-RN and may experience test anxiety about the NCLEX-RN even if they have had little test anxiety before.

To decrease test anxiety, students must understand the mind/body/spirit connection and address the need for proper nutrition, sleep, and exercise before taking tests. A high level of anxiety can have negative consequences including inability to concentrate during study sessions, misreading questions, changing answers, blanking on questions, and having physical symptoms such as diarrhea, sweaty palms, and palpitations. Establishing a faculty advisor and a support group of other students promoted confidence and reduced anxiety.

Test-Taking Skills

Multiple-choice items can be written to require simple cognitive processes such as recognizing a correct answer or recalling isolated facts, or they can be constructed to activate complex cognitive states and complicated performances, including understanding, prediction, evaluation, and problem solving. Multiple-choice items that merely require recall and recognition skills are far less cognitively demanding than items that mandate the retrieval of complex, associative information (ie, declarative or procedural knowledge) from long-term memory.


Critical decision making is the basis for professional nursing and is measured by the NCLEX-RN. A major challenge of nurse educators is to prepare entry-level practitioners for successful completion of this examination by developing critical thinking and critical synthesis skills. By implementing an evidence-based plan that addresses content knowledge, test anxiety, and test-taking skills, nurse educators can promote student success. Incorporating evidence-based strategies allows nursing faculty to promote a positive learning environment with positive student outcomes.

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