Which Is the Hardest Nursing Exam? The NCLEX-RN is widely considered the hardest nursing exam due to its Computerized Adaptive Testing (CAT) format, 95% confidence pass rule, Next-Gen NCLEX (NGN) case studies, and high-stakes licensure requirement. Over 300,000 candidates take it annually, with a 7.9% first-time failure rate (NCSBN 2025) — the highest among nursing exams. While HESI Exit, TEAS, and CCRN exist, NCLEX-RN tops difficulty rankings in pass rates, cognitive demand, and career impact. International nurses often rate it harder than local boards (e.g., India’s INC, UK’s NMC).
Why NCLEX-RN Is the Hardest Nursing Exam
- Adaptive Difficulty: Questions increase in complexity until you’re statistically above or below the 0.00 logit standard. One wrong answer can trigger harder items — no fixed 70% pass.
- NGN Format (2023+): Includes 6-case studies, bowtie, matrix, and drag-and-drop — testing clinical judgment, not just recall.
- Time Pressure: Up to 5 hours, 75–265 questions — 50% stop under 100, but failers max out.
- Content Breadth: 8 client need categories — Prioritization, Delegation, SATA dominate (30–40% of score).
- Stakes: Fail = no RN license — delays jobs, travel nursing, visas.
Which Is the Hardest Nursing Exam: NCLEX vs Others
- HESI Exit Exam: Predicts NCLEX — requires 900/1500 conversion score. 94% pass rate with prep — easier than NCLEX (fixed format, school remediation).
- TEAS 7: Pre-nursing entry — 58–85% cutoff, 209 minutes. 68.9% national average — knowledge-based, not adaptive.
- CCRN (Critical Care): Specialty cert — 70% pass rate, 150 questions. Harder content, but not required for practice.
- ANCC Med-Surg Cert: 71% pass, 175 Qs — post-licensure, less pressure. Verdict: NCLEX-RN > all in adaptive stress + licensure gatekeeping.
Hardest Parts of NCLEX-RN: 2025 Data
- SATA (Select All That Apply): 15–20 per exam — 60% fail rate per question (UWorld).
- Pharmacology: 15% of test — side effects, interactions, IV calcs.
- NGN Case Studies: 18 points each — require full patient analysis.
- Psych/Maternity: High fail zones for non-clinical grads.
How to Conquer the Hardest Nursing Exam (NCLEX-RN)
- Use Nurselytic (2,200+ Qs): 70% average = 99% pass.
- Archer CAT Exams: 4–6 full simulations — stop at 75 Qs.
- Mark Klimek Audio: 12 hours — Pharm, Labs, Prioritization.
- Study 250–300 hours over 8–12 weeks.
- Remediate every rationale — spaced repetition.
Who Finds NCLEX Hardest?
- International Nurses: ESL + system differences — 45% fail first try.
- >3 Years Post-Grad: Knowledge decay — <80% pass.
- ADN vs BSN: ADN slightly lower (89% vs 93%).
Final Answer: Hardest Nursing Exam Confirmed
NCLEX-RN is the hardest — adaptive, high-stakes, NGN-driven. But 98% pass with UWorld + strategy. Start prep today — your license depends on it.