NCLEX-RN, test format, structure and registration in Australia

By NETA Dec 20, 2020


What is NCLEX-RN exam?

The NCLEX-RN is short form of National Council Licensure Examination for Registered Nurses is a exam that tests application and analysis using the nursing knowledge learned in nursing school, where the test takers will be tested on how one can use critical thinking skills to make nursing judgements. This test serves one purpose and that is to determine if it’s safe for you to begin practice as an entry-level nurse.

Very important to note here is this exam is significantly different from any test that you took in your nursing University or college.


The NCLEX-RN® exam is organized according to the framework, "Meeting Client Needs." There are four major categories and eight subcategories. Many nursing programs are based on the medical model where students take separate medical, surgical, paediatric, psychiatric, and obstetric classes. However, on the NCLEX-RN® exam, all of the content is integrated.

NCLEX-RN® questions are organized along four major Client Needs Categories. Let's take a look:


The first Client Needs Category, Safe and Effective Care Environment, includes two concepts:

 a. Management of Care accounts for 17-23% of questions on the NCLEX-RN® exam. Some of the nursing actions included in this subcategory are Advanced Directives, Advocacy, Case Management, Client Rights, Concepts of Management, Confidentiality, Continuity of Care, Quality Improvement, Delegation, Establishing Priorities, Ethical Practice, Informed Consent, Legal Responsibilities, Referrals, and Supervision.

b. Safety and Infection Control accounts for 9-15% of exam questions. Nursing actions include Accident Prevention, Error Prevention, Hazardous Materials, Surgical Asepsis, Standard Precautions, and Use of Restraints.


The second Client Needs Category is Health Promotion and Maintenance. These questions account for 6-12% of the exam. Nursing actions tested include the Aging Process, Ante/Intra/Postpartum and Newborn Care, Developmental Stages and Transitions, Disease Prevention, Health Screening, Lifestyle Choices, Physical Assessment Techniques, Health Promotion Programs, High Risk Behaviors, and Self-Care.


The third Client Needs Category is Psychosocial Integrity. It accounts for 6-12% of the exam and tested nursing actions include Coping Mechanisms, Grief and Loss, Mental Health Concepts, Spiritual Influence on Health, Sensory/Perceptual Alterations, Stress Management, Support Systems, Therapeutic Communication, Chemical Dependency, Behavioral Interventions, Crisis Intervention, Coping Mechanisms, End of Life Care, and Family Dynamics.


The final Client Needs Category is Physiological Integrity. It includes four concepts:

a. Basic Care and Comfort accounts for 6-12% of questions on the NCLEX-RN® exam. Nursing actions included in this subcategory are Assistive Devices, Elimination, Mobility, Nonpharmacological Comfort Interventions, Nutrition and Oral Hydration, Personal Hygiene, as well as Rest and Sleep.

b. Pharmacological and Parenteral Therapies accounts for 12-18% of the exam. Tested nursing actions include Adverse Effects, Contraindications, Blood and Blood Products, Central Venous Access Devices, Chemotherapy, Expected Effects, Intravenous Therapy, Medication Administration, Pharmacological Pain Management, Total Parenteral Nutrition, and Dosage Calculation.

c. Reduction of Risk Potential accounts for 9-15% of the exam. Its tested nursing actions include Diagnostic Tests, Laboratory Values, Potential for Complications from Surgical Procedures and Health Alterations, as well as Therapeutic Procedures.

d. Physiological Adaptation accounts for 11-17% of the exam. Its tested nursing actions include Alterations in the Body Systems, Fluid and Electrolyte Imbalances, Hemodynamics, Medical Emergencies, Pathophysiology, and Unexpected Response to Therapies.



NCLEX uses CAT format .CAT is an acronym for "computer adaptive test," a testing format that is interactively based on your response to the questions. Based on your skill level, the CAT ensures that the questions are not "too hard" or "too easy.".  For every correct answer the computer will gradually progress you to harder questions to determine your peak knowledge.

Your first question will be relatively easy—below the level of minimum competency. If you answer it correctly, the computer selects a slightly more difficult question. If answered incorrectly, the computer selects a slightly easier question.

By continuing to do this throughout the test, the computer can determine your level of competence.

The test will produce a minimum of 75 questions, and a maximum of 265 questions. A candidate passes the test when the tester has answered enough questions correctly to stay above the pass line with 95% confidence interval. The candidate will fail the test when they do not rise about the pass line with 95% confidence. 

Think of it this way – there is a horizontal line on an axis and we will call it the “pass line.” Anything above it is passing, and anything below it is not passing. You start exactly on the line at question zero, and with each correct and incorrect answer, you get bumped up a notch and down a notch, respectively. With each correct answer, the computer will give progressively harder questions, to determine your peak knowledge. To pass, you must ultimately rise to a point above the pass line that demonstrates competency with marginal doubt. The test can end at any point when this determination is made, between questions 75 – 265, or at the maximum time allowance (6 hours). 

It is not useful to try to self-evaluate as you test. Don’t assume that because you got a few “easy” questions in a row that you are below pass level. Just focus on the questions at hand. What seems easy to you, might be challenging to someone else. Every question is as important as the next. 

This exam is all about endurance. Prepare to sit the full time and then you won’t stress in the chance that you need to.



Questions are primarily multiple-choice with four possible answer choices; however, there are also alternate question types. Alternate question types include multiple-response, fill-in-the-blank, hot spots, chart/exhibit and drag-and-drop. All questions involve integrated nursing content. Let's look at the following question:

A 23-year-old woman with insulin dependent diabetes mellitus (IDDM) is returned to the recovery room one hour after an uneventful delivery of a 9 lb., 8 oz., baby boy. The nurse would expect the woman's blood sugar to



remain stationary


Is this an obstetrical question or a medical/surgical question? In order to select the correct answer, (2), you must consider the pathophysiology of diabetes along with the principles of labor and delivery.



Once you have done your Self Check from AHPRA’s website and uploaded all your certified documents in Portfolio Stage, you will recieve an ATT. Upon receipt of an ATT (authorization to test), you will be able to schedule your test date and time. Testing is available year-round. 


Let’s look at it step by step:

      1.  Recieve advice from AHPRA [on behalf of the Nursing and Midwifery Board of Australia (NMBA)] about how to proceed to the NCLEX-RN® examination — which is the first                          stage of the NMBA’s outcomes-based assessment (OBA) for internationally qualified nurses seeking registration as a registered nurse.

  1. Register and pay the exam fee at Pearson VUE online or by calling Pearson VUE NCLEX Candidate Services. Payment via credit, debit or prepaid card (MasterCard, Visa or American Express) will be accepted.
  2. Receive Acknowledgement of Receipt of NCLEX Registration from Pearson VUE by email
  3. AHPRA makes you eligible to test in the Pearson VUE system. You must be made eligible by AHPRA within 365 days of your NCLEX registration and payment.
  4. Receive Authorization to Test (ATT) email from Pearson VUE. You must test within the validity dates on the ATT (90 days). There are no extensions.
  5. Schedule your exam appointment at Pearson VUE online or by calling Pearson VUE NCLEX Candidate Services at +852.3077.4923. Note—Additional international scheduling fees may apply.
  6. Arrive for the exam appointment with your acceptable identification (passport required for all international appointments) and complete your exam.
  7. Receive your official results from AHPRA up to six weeks after your exam.

 No Refunds There are no refunds of NCLEX fees for any reasons.

The cost to register for the NCLEX-RN® exam is $200. And exam booking fee is $150. These fees are in US dollars. (350 US dollars in total)

 You will not be able to schedule an appointment to take the exam until your AHPRA declares you eligible and you receive an Authorization to Test (ATT) in the mail. If you have not got your ATT after 2 weeks of registration to take NCLEX, contact Pearson VUE.

You might ask:

1. How many questions are there?

Everyone answers a minimum of 75 questions to a maximum of 265 questions. Regardless of how many you answer, you will be given 15 experimental questions that do not count for or against you. The exam administrators use them to test for future questions on the exam.


2. How much time will I have?

There is no time limit for each individual question. You will have a maximum of 6 hours to complete the exam, which includes a tutorial in the beginning. There are no mandatory breaks. However, there is an optional break after 2 hours of testing, and another optional break after 3.5 hours of testing.

3. When does the exam end?

Your exam ends when one of the following occurs:

You have demonstrated minimum competency and answered the minimum number of questions (75).

You have demonstrated a lack of minimum competency and answered the minimum number of questions (75).

You have answered the maximum number of questions (265).

You have used the maximum time allowed (6 hours).

TIP: Try not to focus on the length of your exam. You should just plan on testing for 6 hours and completing 265 questions. And if you have a long exam, remember that you are still in the game as long as the computer continues to give you questions; so focus on answering them all to the best of your ability.

4. What if I fail?

First, don't despair. You are not alone. Many students do not pass the NCLEX-RN® exam on their first attempt. Failing the exam means that you did not successfully answer questions at or above the level of difficulty needed to pass. On this particular exam, you were unable to demonstrate your ability to provide safe and effective care.

If you fail, you'll receive a diagnostic profile that evaluates your test performance. Read it carefully. You'll see how many questions you answered on the exam. The more questions you answered, the closer you came to passing.

The only way you continue to get questions after the first 75 is if you are answering questions close to the level of difficulty needed to pass. Use the diagnostic profile to determine your problem areas. You can then focus your preparation accordingly.

5. Should I test again?

Absolutely. Re-testing for the NCLEX-RN® exam is permitted 45 days after the initial administration.

If you prepared on your own for the first time, you may want to consider a formal preparation option to help you focus your study time more effectively.

NETA is providing online classess and have students from all over the world.

Inside NETA(Nursing Education and Training Australia)’s student portal there are many practice tests, mock tests and a ocean of resources derieved from more than 12 resource books and a question bank with more than 15000 questions. Also educators will provide you with polishing and final coaching sessions and evaluate you if you are ready to take test. All  educators are NCLEX passers themselves and are working in leading positions in  prestigious local health districts. Joining a good preparation course provider means you  allocate the time for study for classes  and you gain the knowledge and strategies to tackle the test and you have all useful resources integrated in one, and educators will be there to guide you in the right direction. If you are choosing to join prep classes for NCLEX for Australia, make sure your educators are NCLEX passers themselves and they are working as Registered Nurses in Australia.

Regardless of the method you choose, don't forget to use the diagnostic profile to guide your preparation.