Clinical Knowledge, Skills and Strategies in NCLEX-RN Exam

Introduction to the NCLEX-RN Exam

The National Council Licensure Examination for Registered Nurses (NCLEX-RN Exam) is a standardized examination that each state board of nursing uses to determine whether or not a candidate is prepared for entry-level nursing practice. It is a requisite exam for nursing licensure and measures the competencies needed to perform safely and effectively as an entry-level nurse.

The NCLEX-RN Exam is a computer adaptive test (CAT), meaning the test adapts to the ability level of the test taker. It uses advanced algorithms to assess the competence level of the candidate, adjusting the difficulty of questions based on previous responses. This makes the NCLEX-RN Exam not just a measure of knowledge, but also an evaluation of critical thinking and decision-making skills, which are key to competent nursing practice.

The examination covers various areas of nursing, including physiological integrity, safe and effective care environment, health promotion and maintenance, and psychosocial integrity. The NCLEX-RN Exam aims to ensure that only those candidates who have the necessary knowledge and skills are licensed as registered nurses. Preparing for the NCLEX-RN Exam involves comprehensive study and understanding of nursing fundamentals, pharmacology, medical surgical nursing, pediatric nursing, obstetric and gynecological nursing, among other areas. The exam also tests the candidate’s ability to apply this knowledge in different clinical scenarios, reinforcing the importance of practical competence in the field of nursing.

NCLEX-RN Exam is an essential step in becoming a registered nurse in the United States. Its comprehensive nature ensures that licensed nurses are adequately prepared to handle various situations in their professional practice, thus safeguarding the health and wellbeing of their patients.

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Importance of Clinical Knowledge in the NCLEX-RN Exam

The importance of clinical knowledge in the NCLEX-RN exam cannot be overstated. This test, which is a requirement for licensure as a registered nurse in the United States, is designed to evaluate the competency and readiness of nursing candidates to practice safely and effectively at the entry-level.

nurse pointing to clinical knowledge

A significant portion of the exam is dedicated to assessing a candidate’s clinical knowledge, reflecting its critical role in nursing practice. Clinical knowledge refers to the practical understanding and expertise in applying medical and nursing concepts in real-life healthcare settings. It encompasses a wide range of areas, including patient care, pharmacology, physiology, pathophysiology, and more. Unlike theoretical knowledge, which can be gained through textbooks and lectures, clinical knowledge is usually developed through hands-on experience in clinical settings.

In the NCLEX-RN exam, a candidate’s clinical knowledge is tested through various types of questions, such as multiple-choice, fill-in-the-blank calculation, ordered response, and hot spot items. These questions are designed to assess the candidate’s ability to make sound judgments and decisions based on their clinical knowledge in different healthcare scenarios. For instance, a candidate may be asked to choose the most appropriate nursing intervention for a patient with a specific health condition or to prioritize care for multiple patients with different needs.

Moreover, the NCLEX-RN exam not only tests a candidate’s recall of clinical facts but also their understanding of how these facts apply in practice. This underscores the importance of having strong clinical knowledge. Without it, candidates may struggle to answer questions correctly and efficiently during the test. Clinical knowledge is essential for success in the NCLEX-RN exam. It forms the bedrock upon which nursing candidates can demonstrate their competence and readiness to provide safe and effective care. Therefore, nursing students preparing for this test should focus on developing and strengthening their clinical knowledge through both theoretical studies and practical experiences in clinical settings.

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Developing Clinical Skills for NCLEX-RN Exam

The NCLEX- RN exam measures a candidate’s capability to apply knowledge and clinical skills necessary for safe and effective entry-level nursing practice. Therefore, developing clinical skills is pivotal to passing the NCLEX- RN exam.

nurse reading a book

Clinical skills encompass a wide range of abilities that are integral to the practice of nursing, such as patient assessments, drug administration, and critical thinking. These skills are directly linked to patient safety and care quality. Thus, they form a significant portion of the NCLEX- RN exam. Similarly, an effective preparation strategy should center on enhancing these skills. One way to develop clinical skills is through simulation exercises that replicate real-life clinical situations. These exercises give a safe setting for candidates to exercise their clinical skills and receive immediate feedback on their performance. They can also help candidates get familiar with the type of scenarios they may encounter during the NCLEX- RN exam.

Another critical aspect of developing clinical skills is gaining practical experience. Internships or work placements in healthcare settings can provide invaluable opportunities for candidates to apply their theoretical knowledge in real-world situations. This hands-on experience can enhance their understanding of nursing practice and sharpen their decision-making abilities. Ultimately, it’s essential to review and understand the guidelines and protocols set forth by various health institutions. Knowledge of these procedures is integral to performing numerous clinical tasks and is frequently tested in the NCLEX- RN exam.

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Incorporating Revised Bloom’s Taxonomy in NCLEX-RN Exam Preparation

The Revised Bloom’s Taxonomy, a tool that structures learning objectives based on complexity and specificity, can significantly enhance the NCLEX-RN exam preparation process.

cycle of cognitive process

This taxonomy is often used by educators to develop curriculum, create tests, and assess student learning. By incorporating the Revised Bloom’s Taxonomy into NCLEX-RN exam preparation courses and study programs, students can gain a deeper understanding of nursing concepts and improve their critical thinking skills, which are crucial for passing the exam and succeeding in their nursing careers.

The Revised Bloom’s Taxonomy includes six levels of cognitive learning: remember, understand, apply, analyze, evaluate, and create. These levels progress from basic recall of facts to higher-order thinking skills. For NCLEX-RN exam preparation, students can start by memorizing key nursing facts and concepts (remember), then move on to understanding the underlying principles (understand), applying this knowledge to different scenarios (apply), analyzing complex patient situations (analyze), evaluating possible interventions (evaluate), and finally creating effective care plans (create).

Incorporating the Revised Bloom’s Taxonomy into NCLEX-RN exam preparation not only helps students understand what they are expected to know for the exam but also equips them with essential critical thinking and decision-making skills. These skills are not only important for passing the NCLEX-RN exam but also for practicing as a registered nurse. Moreover, using the Revised Bloom’s Taxonomy can also help students identify gaps in their knowledge and understand how different concepts connect with each other, which can further enhance their learning efficiency and effectiveness.

The Revised Bloom’s Taxonomy can be a valuable tool for NCLEX-RN preparation. By structuring study materials and practice questions based on this taxonomy, students can systematically build up their knowledge and skills, making them well-prepared for both the exam and their future nursing practice.

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1. Remembering:

The first step is to memorize things by multiple approaches such as assessing again and again, doing them by yourself, evaluating causes and effects, and trial and error. Secondly, practice recalling your memorized things by multiple methods like making lists, tables, and graphs. For example, if you have read the client’s blood sugar level how you can recognize whether the results are normal, high, or low? The answer is that you need to remember normal ranges first if you know that 70-99 mg/dL or 3.9-5.5mmol/L are normal results then you can evaluate results efficiently.

To remember such kinds of values you need to make a mental map. To make your mental map you need to create unique ideas in your mind. Simply you need to create unique families for every value for example in Sugar’s family Mr. Sugar is 99 years old and Mrs. Sugar is 70 years old anything lower or higher their age might be their parents or children who are not normal because you did not allow them to keep their parents or children in their family.

genogram of sugar family

2. Understanding:

It is the process of determining the complete meaning of any idea, concept, or information. Understanding is a very crucial part of your cognitive process. Confusing questions could affect your understanding of a complete idea and meaning and lead to poor progress in exams. To overcome this obstacle first thing you need to break the complete information into small parts and focus on the keywords. For example, The nurse notes that the client’s peripheral site is edematous, blanched, and cool based on this observation what should a nurse do first?

  1. Aspirate and check for blood return
  2. Apply the warm compress on affected area
  3. Measure the edematous area
  4. Remove the IV line

The answer could be confusing in this case because all the answers are applicable. So break the information into simple small parts and rationales. For this kind of problem, you need to focus on the keyword which is “first” which means you need to prioritize patient care. Other focus keywords are “edematous, blanched, and cool” which represent the accumulation of intravenous fluid in the surrounding tissue which is called infiltration. Now focus on the harmful effects of infiltration and preventive measures for further damage. The priority action to prevent the patient from further harm is to remove the IV line. Further management may include measuring the damaged area and applying a warm compress.

3. Applying:

Application or execution of your psychomotor skills affects your overall performance and results. Results depend on carrying out your appropriate action. The nursing process is the best tool to execute any action for your client. Make a concept map to handle critical situations. Before selecting any answer in the NCLEX exam you need to think conceptually.

For example, a nurse receives a 45 years old client in HDU whose post-operative day is 1 after distal gastrectomy with abdominal surgical wound, abdominal drain, Foley’s catheter, NGT, epidural analgesia, peripheral lines, ineffective cough, rapid breathing, and facial grimace. The pain score is NRS. 5/10 and his FRAT score is 7/13. O2 saturation: 94%, Temp: 36.4C, Pulse:101 b/min, Resp:22/min, BP: 155/90 mmHg. What should a nurse do?

Nursing Tip:

Make a map in your mind and advance with a rationale. You need to improve the client’s effective cough, normal breathing pattern, and pain. In an umbrella approach your one action will affect multiple targets.

4. Analyzing:

Your analysis should be very specific and concise interprets your results and make relations of concepts with each other. Break the collected data into small parts and relate them with each other and analyze that either they have direct or indirect relations. Think about how effective pain management will improve the patient’s cough which will decrease the risk of aspiration. Finally, the client will be prevented from any lung infection and complications. Let’s make a concept map.

concept map of key problems

Red arrows show the direct links with the problems and green arrows show the indirect links. Managing the client’s pain effectively will improve the client’s physical mobility because the client feels the pain whenever he moves. Due to pain client is reluctant to an effective cough which will increase the risk of aspiration. Managing pain will improve the client’s cough and deep breathing. Conclusively, if you are applying any action, assess, think, analyze and take action and prioritize the action which affects multiple problems.

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5. Evaluating:

You are determined to improve the client’s overall condition. So if you have assessed the client and analyzed that effective pain management will improve the client’s overall condition and you took actions to manage pain effectively. Now you have to see whether your actions made positive or negative effects on the client’s condition. In the same way, if you are in an exam how will you evaluate if you are choosing a right or wrong answer? For example, a client with pneumonia at risk for developing shock is agitated, confused, and restless with a low blood pressure of 90/60 mmHg and decreased urine output. Based on this data nurse anticipates which stage of shock?

  • Stage 1
  • Stage 2
  • Stage 3 
  • Stage 4

The answer is 2. In septic shock stages, the first stage is characterized by tachycardia, pale and cool skin, and restlessness. In the second stage blood pressure decrease than 100 mmHg systolic, cardiac output decreases by 4 to 6 liters per minute, cerebral perfusion decreases than 70 mmHg, confusion aggravates and urine output also decreases. In stage three, edema appears, excessive hypotension and dysrhythmias occur and the pulse becomes weak and thready. In stage four, blood pressure becomes unresponsive to vasopressors, and profound hypotension, bradycardia, and multiple organ failure take place.

Nursing Tip:

For remembering the stages of shock you can use the same strategy by making a family tree of shock. Let’s suppose Mr. Shock has four children first two are females Mrs. Stage 1 and Mrs. Stage 2 and the second two are males Mr. Stage 3 and Mr. Stage 4. They all are married and have children and grandchildren.

Mr. Shock's disease genogram

Based on your clinical knowledge, mind mapping, and creating unique techniques you can solve any puzzle in the exam, evaluate your data, eliminate the wrong answers, and choose the best answer.

6. Creating:

Creation is the best strategy to learn any kind of subject. Whenever you create, you train your mind to work in a specific way. For example on a green hill whenever you try to pass through it means you are trying to create something, which is your own “way”. If you don’t find it convenient you will try to find another way until your mind accepts the most convenient way. You pass through on daily basis in the same way and after some days you will notice that a pathway is appeared on that way by pressing gross.

Your brain works in the same manner you try to create your convenient way to pass through any information you create different techniques if you find one useless you adopt another technique until your strategy starts working and you do it again and again. Finally, your brain trains itself to work in such a way.

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Effective Strategies for Passing the NCLEX-RN Exam

NCLEX-RN is a challenging exam that requires diligent preparation and execution of effective strategies to ensure success. One of the most effective strategies for passing the NCLEX-RN exam is to understand the test format and pattern. The exam is primarily multiple-choice, but it also includes alternate format questions like select-all-that-apply, fill-in-the-blank, and chart/exhibit questions. Familiarity with these question types can reduce anxiety and improve performance.

Another strategy includes consistent and organized studying. Establishing a study schedule that allows for regular reviews of material over an extended period can increase retention and understanding. It’s advisable to focus on one topic at a time, mastering it before moving on to the next. Using NCLEX-RN review books and practice questions can also be beneficial. Effective strategies also involve focusing on improving critical thinking and decision-making skills as they are integral to nursing practice. The NCLEX-RN exam tests not only factual knowledge but also the application of this knowledge in different clinical scenarios. Regular practice with case studies and scenario-based questions can help enhance these skills.

Lastly, maintaining physical health and mental well-being are equally important strategies. Adequate sleep, good nutrition, regular exercise, and stress management techniques can significantly influence cognitive function and test performance. Passing the NCLEX-RN requires more than just memorizing facts. It demands a comprehensive approach that includes understanding the test format, consistent studying, enhancing critical thinking skills, and maintaining good health. By following these effective strategies, candidates can increase their chances of achieving their goal of becoming registered nurses.

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Resources to Improve Clinical Knowledge and Skills for NCLEX-RN Exam

The NCLEX-RN exam, a crucial milestone in the career of any aspiring nurse, requires a solid foundation of clinical knowledge and skills. It is an extensive examination that demands a strategic approach and a high degree of preparation. Fortunately, there are a variety of resources available to help candidates prepare effectively for this strenuous exam.

One such resource is the National Council of State Boards of Nursing (NCSBN) website. This official site provides candidates with a comprehensive overview of the NCLEX-RN exam, including examination structure, content, and scoring. Another highly recommended resource is the selection of NCLEX-RN review books available in the market, such as the Saunders Comprehensive Review for the NCLEX-RN Examination. These books offer in-depth coverage of all exam topics along with practice questions and tests.

Online learning platforms and websites are other valuable resources that provide a plethora of study materials including video tutorials, quizzes, flashcards, and practice tests. Websites such as UWorld, and Nurse Plus offer specialized NCLEX-RN preparation courses designed to enhance clinical knowledge and skills. Moreover, live workshops and seminars conducted by experienced professionals in the field serve as excellent resources to gain real-time insights into clinical practices. Interactive sessions in these workshops offer hands-on experience and provide opportunities to clarify doubts and understand complex topics.

Furthermore, participation in study groups and forums can also be instrumental in improving clinical skills and knowledge. These platforms offer the chance to interact with fellow aspirants, share knowledge, discuss doubts, and gain a better understanding of various clinical concepts. Finally, utilizing these resources can significantly enhance a candidate’s preparation for the NCLEX-RN Exam. However, it is important for candidates to choose resources that best suit their learning style and needs. Consistent effort, diligent practice, and effective use of these resources can pave the way for success in the NCLEX-RN Exam.

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Conclusion: The Role of Clinical Knowledge, Skills, and Strategies in Passing the NCLEX-RN Exam

In conclusion, the role of clinical knowledge, skills, and strategies in passing the NCLEX-RN exam is vital. This examination, which determines the readiness of nursing graduates to enter the nursing profession, places a significant emphasis on the application of clinical knowledge garnered throughout the study. This clinical knowledge plays a foundational role, as it underpins a nurse’s understanding of patient care, medication administration, disease processes, and the healthcare system in general. Without a firm grasp of this knowledge, nursing graduates may find it challenging to pass the NCLEX-RN exam.

Furthermore, the skills acquired during nursing education also play a crucial role in successfully passing this examination. These skills – including critical thinking, problem-solving, and practical nursing skills – are vital for working effectively in a healthcare setting. The NCLEX-RN exam tests these skills rigorously, ensuring that only those who can apply these skills in real-life scenarios are deemed fit for the profession. Lastly, strategies also hold an integral role in passing the NCLEX-RN exam. These strategies include time management, effective study habits, and utilization of resources such as practice tests and review courses. It is through these strategies that nursing graduates can increase their efficiency and effectiveness in tackling exam questions.

In essence, clinical knowledge, skills, and strategies all play crucial roles in passing the NCLEX-RN exam. They are intertwined elements that work together to ensure that a nursing graduate is not only able to pass an examination but also perform effectively and efficiently in their professional practice. As such, nursing students must focus on building their clinical knowledge base, honing their nursing skills, and adopting effective study strategies to increase their chances of success in the NCLEX-RN exam.


Silvestri, L.A. and Silvestri, A.E., 2019. Saunders Comprehensive Review for the NCLEX-RN® Examination-E-Book.

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