Test Prep Toolkit

The Odds of Passing the NCLEX with 145 Questions [Explained]

NCLEX · By Sean · · Updated · 4 min read

Nursing student practicing patient care on a simulation mannequin
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Photo by Monirb, CC BY-SA 4.0, via Wikimedia Commons

The NCLEX (National Council Licensure Examination) is the exam you must pass to be licensed as a registered nurse (NCLEX-RN) or a licensed practical/vocational nurse (NCLEX-PN) in the United States.

Since the Next Generation NCLEX launched on April 1, 2023, both exams give between 85 and 150 questions in a five-hour window. Under the 2019 RN test plan, used until April 2023, the exam ran 75 to 145 questions, which is why "145 questions" comes up so often: it used to be the maximum.

So what does it mean if your exam reaches 145 today, close to the new maximum of 150?

Deciphering the NCLEX

The NCLEX is a computerized adaptive test (CAT). After each answer, the computer re-estimates your ability and picks the next question to match it.

The exam is built to measure clinical judgment, not rote memorization. The RN test plan includes three clinical judgment case studies of six items each, plus stand-alone items across eight content areas such as Management of Care and Pharmacological and Parenteral Therapies.

Every exam also includes 15 unscored pretest items. You can't tell which ones they are, so treat every question as if it counts.

How the NCLEX Decides When to Stop

According to the NCLEX-RN test plan, three rules decide whether you pass or fail:

  1. 95% confidence interval rule: The most common outcome. Once you reach the minimum of 85 items, the exam 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 passing standard, the exam keeps going to the maximum of 150 items. The computer then ignores the 95% rule and looks only at your final ability estimate: at or above the standard is a pass, below is a fail.
  3. Run-out-of-time rule: If time runs out before the maximum, you fail if you haven't answered the minimum number of items. Otherwise, you're scored on the final ability estimate from all the items you completed.

So 145 questions isn't a "magic number," and it doesn't predict a pass or a fail. It means your performance was close to the passing standard, and the computer needed more items to decide. Plenty of candidates pass with a long exam, and plenty pass with a short one.

Preparing for the NCLEX

Preparation matters far more than the number of questions you see. A good study plan covers every Client Needs category on the test plan: Management of Care, Safety and Infection Prevention and Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential and Physiological Adaptation.

Balance content review with timed practice questions, including NGN-style case studies.

Top Resources for NCLEX Preparation

  1. Saunders Comprehensive Review for the NCLEX-RN Examination: A review book covering nursing content and NCLEX-style questions, with explanations for each answer.
  2. NCLEX-RN Practice Questions Exam Cram: A book of practice questions and test-taking strategies.
  3. UWorld NCLEX: An online question bank with performance tracking.
  4. Kaplan NCLEX Prep: An online course with lectures, practice questions and customizable quizzes.

Whatever you choose, make sure it reflects the current Next Generation NCLEX format.

Conquering Test Anxiety

A long exam can feel alarming in the moment. Here’s how to keep anxiety in check:

  1. Create a Study Plan: A structured study plan keeps you on track and reduces anxiety.
  2. Practice Relaxation Techniques: Deep breathing and short mental resets help between questions.
  3. Prioritize Rest: Lack of sleep amplifies stress, so protect your sleep in the weeks before the exam.
  4. Don't Count Questions: The exam length tells you little about your result, so focus on the item in front of you.

Mastering NCLEX Questions

Types of NCLEX Questions

  • Multiple-choice questions: One correct answer. Read carefully and eliminate wrong options.
  • Multiple-response and other formats: Some items have more than one correct answer, and many are built around an unfolding client case with charts, tables or other exhibits. The official NCLEX Candidate Tutorial shows each format.
  • Partial credit: Items with more than one key can earn partial credit, so think through each option instead of guessing all-or-nothing.

Strategies for Answering NCLEX Questions

  1. Familiarize Yourself with the Test Format: Work through the official NCLEX candidate tutorial and practice with case studies before test day.
  2. Break Down Complex Questions: Identify what the question asks, then use the clinical judgment steps (recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes).
  3. Prioritize Safety: When unsure, choose the answer that protects the client first.
  4. Take Timed Practice Exams: Full-length practice builds stamina for a five-hour window.
  5. Pace Yourself: If you reach 145 items, you still need time to finish all 150, so don't rush early or stall late.

Final Thoughts

Seeing 145 questions on the NCLEX doesn't mean you failed. It means the exam needed more information to make a decision. Prepare across the full test plan, practice NGN-style items, and keep your pace steady through the end.

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