NCLEX-RN Guide 2026: NGN Format, CAT, ATT and Pass Rates

The NCLEX-RN is the licensing exam for registered nurses in the United States. Canadian regulators and Australia use it as well. It is developed by the National Council of State Boards of Nursing (NCSBN). Every US state and territory uses it to decide whether a candidate has the minimum ability to practice nursing safely and effectively at entry level. The current exam is the Next Generation NCLEX (NGN), which uses case studies to measure clinical judgment explicitly.

NCLEX-RN at a glance

Format and the Next Generation NCLEX

The NCLEX-RN is organized around four Client Needs categories, two of which have subcategories:

• Safe and Effective Care Environment (management of care, safety and infection prevention and control)
• Health Promotion and Maintenance
• Psychosocial Integrity
• Physiological Integrity (basic care and comfort, pharmacological and parenteral therapies, reduction of risk potential, physiological adaptation)

Integrated across all categories are the nursing process, caring, clinical judgment, communication and documentation, teaching and learning, and culture and spirituality. The test plan sets the percentage of items per category.

What NGN changed

The Next Generation NCLEX measures clinical judgment directly. Clinical judgment is measured by 18 case study items (three item sets) and approximately 10% stand-alone items, selected depending on exam length. A case study presents an unfolding patient scenario. Across several items you recognize cues, analyze them, prioritize hypotheses, generate solutions, take action and evaluate outcomes.

NGN uses several item formats beyond classic single-answer multiple choice. Items with more than one correct key can earn partial credit, scored by plus/minus, zero/one or rationale scoring. Practicing these formats before test day matters as much as content review.

How CAT works

Each time you answer, the computer re-estimates your ability and picks the next item based on all your answers so far. Items are chosen so that you have roughly a 50% chance of answering correctly. This is why the exam feels hard for everyone. It is designed that way.

The exam stops under one of three rules:

1. 95% confidence interval rule (most common). Testing stops as soon as the computer is 95% certain your ability is clearly above or clearly below the passing standard.
2. Maximum-length rule. If your ability is very close to the standard, you continue to the maximum number of items. The final ability estimate then decides: at or above the standard passes, below it fails.
3. Run-out-of-time rule. If time expires before either of the above, candidates who have not answered the minimum number of items fail. Otherwise the final ability estimate decides.

What this means for you:

• The number of items says nothing on its own. Candidates pass and fail at the minimum length. In 2025, 59.1% of first-time US-educated RN candidates took the minimum number of items and 20.5% took the maximum.
• Don't rush. Running out of time with fewer than the minimum items answered is an automatic fail.
• Don't guess wildly early. Every response feeds the ability estimate.

Eligibility, registration and the ATT

Eligibility to test is decided by the nursing regulatory body (NRB) in the state or jurisdiction where you want a license. Requirements vary, but generally include completing an approved nursing education program and, for internationally educated nurses, a credential evaluation and sometimes an English proficiency test.

The registration process:

1. Apply to your NRB for licensure/registration and follow its requirements.
2. Find your program code in the NCSBN program code list. You need it to register.
3. Register with Pearson VUE online or by phone and pay the fee. Your first and last name must match your exam-day ID exactly.
4. Watch for confirmation by email, usually within two days. Pearson VUE communicates only by email.
5. Wait for eligibility. Your registration stays open for 365 days. If the NRB has not made you eligible within that time, you lose the registration and fee.
6. Receive your Authorization to Test (ATT) by email once you are eligible, and schedule your exam within the ATT's validity dates.

The ATT validity period is set by the NRB. The average is 90 days. You can't extend it, so schedule promptly. Accommodation requests go to the NRB before you register.

Fees (as of October 2026)

The US registration fee rises to $350 from February 1, 2027. For Canadian licensure, the fee is $360 CAD, rising to $570 CAD from the same date. State board application and licensing fees are separate and vary.

Results

Your NRB issues official results. In jurisdictions that take part, you can get unofficial "quick results" through your candidate profile after two business days for a small fee; the service is not available in every state. Official results normally come from your NRB within about six weeks, depending on the board.

If you fail, you receive a Candidate Performance Report showing how you did in each content area. Use it to focus your next round of study. You can retake up to eight times a year with at least 45 test-free days between them, unless your jurisdiction is stricter.

Pass rates (2025)

For the NCLEX-RN for US licensure, January 1 to December 31, 2025:

Among first-time US-educated candidates in 2025, the pass rate was 87.6% for baccalaureate graduates and 86.1% for associate degree graduates. For first-time Canada-educated candidates seeking Canadian licensure or registration, the 2025 rate was 86.0%.

The key takeaway for internationally educated nurses: fewer than half of first-time candidates passed in 2025, and repeat rates are lower still. Common reasons include unfamiliarity with US practice standards, delegation and prioritization rules, NGN item types, and English used under time pressure. All of these can be trained.

How to prepare

1. Download the current test plan and use the Client Needs categories as your syllabus.
2. Take a baseline practice test in CAT-style or timed conditions to find weak categories.
3. Study by category, practice by mixed sets. Content review in the morning, mixed question sets in the afternoon.
4. Train every NGN item type. Do case studies regularly so every NGN item format feels routine.
5. Master prioritization and delegation. ABCs, Maslow, safety first, and what can be delegated to whom under US scope of practice.
6. Review rationales, not just answers. For each item, know why the wrong options are wrong.
7. Use spaced repetition for lab values, medication classes and infection control precautions.
8. Simulate the full exam at least once, with a five-hour limit.

MediFlow's NCLEX-RN course has free practice questions, and you can continue short sets in the app between shifts.

A sample eight-week plan

There is no official study duration. This template assumes you have finished your nursing program and can study most days. Stretch it if you work full time.

For internationally educated nurses, add time for US-specific topics: scope of practice, delegation to licensed practical nurses and assistive personnel, legal and ethical standards, and documentation. These are areas where practice in your home country may differ.

Common mistakes

• Reading meaning into the item count. Stopping at 85 items doesn't tell you whether you passed or failed.
• Letting the ATT lapse. Schedule as soon as you receive it.
• Name mismatch. Your registration name must match your ID exactly.
• Studying only multiple choice. NGN case studies are a fixed part of every exam.
• Answering from home-country practice instead of US standards and scope.
• Retesting too soon without changing the plan. Use the performance report to rebuild your approach.

NCLEX-RN checklist

• NRB requirements met, application submitted
• Program code found, Pearson VUE registration done
• Fee paid (note the 2027 increase)
• ATT received and exam scheduled within its window
• Test plan downloaded, baseline practice test done
• All NGN item types practiced
• Full five-hour simulation completed

Related guides

For job prospects after licensure, see Physician and Nurse Jobs Outlook in the USA. If you are considering medicine instead, read Medical School in the USA and the USMLE Step 1 guide.