How to Tackle Test Anxiety on the NCLEX

  • 11 April, 2022

It's time! It's time to take the NCLEX-RN® and realize your dream of becoming a nurse. It's also the time that your brain and body can start to take out their revenge on you - your stomach is in knots, your mind is blank, your hands are sweating so much they slip right off the mouse, your heart is pounding so hard that surely everyone else in the room can hear it. Yes, the dreaded test anxiety is threatening to derail your testing experience. But we're not going to let that happen!

Test anxiety (or performance anxiety) is excessive worry or fear of a poor outcome. The anxiety can manifest either before, during, or even after a test and can cause physiological and psychological responses. The physiological responses could include rapid heartbeat, shallow breathing (possibly leading to hyperventilation), sweating, shaking, dry mouth, nausea (and all the unpleasant bodily functions associated with nausea), or even fainting. You might find yourself fidgeting or doing all the nervous tics you usually are able to control, such as tapping your foot or leg, playing with your hair, or making noises. Psychological manifestations could include sleeplessness, restlessness, irritability, negative or catastrophic thinking, obsessive thoughts, or memory impairment. It's easy to let our mind go down the rabbit hole of "what if I don't pass" and let our mind and body spin out of control. The mind-body connection with anxiety is incredible. The more you think about something, the more your body responds to those thoughts through physiological responses. Anxiety is a very real thing. But here's the thing to remember about anxiety - we can overcome it!

Test anxiety can happen with any test, from the spelling test in elementary school, all the way to the high-stakes tests we take as adults such as the NCLEX-RN to become a registered nurse. So, let's look at a few ways you can take charge of the anxiety before it takes charge of you.

How to Tackle Test Anxiety on the NCLEX

First, you need to make sure you have done what you can to prepare for the test and prepare for anxiety BEFORE it's test day.

1. Do Your Prep Work

The more prepared you are for your exam, the less you need to worry! Seriously, if you've followed the advice from your instructors and have done a good, solid preparation for the NCLEX, then you've done what you can. That's all anyone can ask from you.

2. Take Care of Your Body

In the weeks leading up to your NCLEX test date, be sure you are taking care of your body to help it function at its best. That means getting enough sleep each night, exercising, and eating good sources of protein rather than high sugar/carbs.

3. Take Care of Your Mind

Try to keep your stress level down for the week or 2 before your exam (yeah, I know...that's easier said than done!). You can do this by reducing the number of commitments you have outside of school or studying - learn to say 'no' to extra things and let the people in your life know why you are doing this. Find ways to reduce your stress. For some people this is through exercise while for others it might mean spending an afternoon painting or doing a craft. Find time for some mindfulness exercises. Some of my favorite free exercises can be found here. One thing mindfulness can teach you is to not judge or chastise yourself for experiencing anxiety symptoms - just notice or observe how you're feeling and let it be - the 4th exercise on the link above is great for this! The more we fight the symptoms of anxiety, the stronger they can feel. So, if you learn to just notice that your holding extra tension in a certain area (I hold my tension and stress in my neck/shoulders), then you can be aware of it, name it, and move on without letting it take over your whole body. The 6th exercise on the Mindfulness Exercises link helps with learning to not judge those thoughts that can sometimes overtake us. Recognize the thought, don't judge it or fight it, and then let it go. I once heard a therapist talk about this as putting your thoughts on a conveyor belt - the thought comes into your heard and onto the belt, watch it travel along the belt and recognize that it's just a thought and not reality, and then let it fall off the belt and away from you. So, when you think "I'm never going to be able to pass this test" just let that thought move on down the belt and fall away from you because it's not reality!

4. Think Positively

Sometimes you have to fake it until you make it, right? If you have to fake those positive thoughts at first, that's ok, but keep telling yourself that you have done the work, you have studied what you need, and you are going to pass the NCLEX and become a nurse. Have you ever seen a basketball player standing at the free-throw line throwing an imaginary free-throw before throwing the real thing? The player is visualizing the ball going through the hoop and being positive. Now, it's your turn to visualize your results - write your full name on a piece of paper and then add RN after it. Put that paper somewhere you will see it.

Now, those are all things you can do ahead of time to help reduce anxiety, but what about when it's test day and your body is exacting revenge? What do you do then?

5. Breathe

The most important thing you can do with anxiety is breathe. Your brain needs oxygen to think straight, so give it the oxygen it needs! Slow, deep, even breaths are relaxing to your brain and body. Breathe in through your nose and blow out through your mouth with pursed lips (just like you'd teach someone with COPD, right?). Try thinking this as you breathe: "breathe in...2...3...4... breathe out...2...3...4...5...6... breathe in...2...3...4... breathe out...2...3...4...5...6...7... breathe in...2...3...4... breathe out...2...3...4...5...6...7...8..." continue adding to the exhale as you can. Not only does this exercise help your body get calm and composed, but it makes your brain focus only on your breathing and counting.

6. Close Your Eyes

If looking at the testing screen starts to become overwhelming, close your eyes. Close your eyes and picture yourself in your happy place. I have learned to visualize myself at the beach - I can be sitting in any situation in any environment but be at the beach in my mind! Yes, I can feel the sand between my toes, smell the salt in the air, and hear the waves crashing. Maybe you enjoy being at a carnival - can you hear the music playing from the Ferris wheel, smell the food trucks, and see the smiling kids running around? If you're reading a specific test question that becomes overwhelming or anxiety-producing, close your eyes and imagine yourself in class talking about the question or in a clinical setting dealing with a client that has that problem. What did you learn in class or in clinical that is going to help you answer this question?

7. Move On...Or Just Move

If you get to a question that makes your whole body feel like it's going to shut down, maybe it's time to move on. Make an educated guess and move on to the next question. If that doesn't feel like the right solution, maybe you just literally need to move! Raise your hand to signal to the testing center that you need a break. Get up and walk in the area they allow you to walk (usually a hallway or the lobby), stretch your arms out wide, reach your arms up as high as you can, bend over and touch your toes, heck do some jumping jacks or run in place if you need to! Just get your body moving and the blood flow improved so you're ready to continue with the test.

8. It Will Be OK

No matter what the results are from your test, you will still be ok! Nothing changed about YOU from the time you walked into the testing center until the time you finished the test to change who YOU are. Passing the test is great. Not passing the test is not the end of the world, and you will take it again. In fact, the great thing about the NCLEX is that you can keep taking it!

But remember how I mentioned that test anxiety can occur even after taking a test? Yes, those dreadful 24-48 hours (or more) that you have to wait for your results can be agonizing, but how you respond can make it even worse. For example, the morning after I took my exam, I was up at 3:00 am obsessively refreshing my board of nursing website to see if anything came up for my name. 3:00 am. Seriously. Every time I hit refresh and didn't see my name my anxiety got a little higher and my negative thinking got a little more out of control. So first, don't be like me - don't obsessively check any websites! Set a time that you will check, and if there's nothing there, then set another time several hours later to check again, and don't let yourself check before then! And then put into practice some of the same tips that you used before the test - exercise, mindfulness, taking care of yourself - but this time you can add in a way to treat yourself or distract yourself!

These tips for dealing with anxiety before, during and after the NCLEX aren't just for test-time. These tips can help you with your stress during all times of your life. Remember when I said I can be at the beach any time I want? I use that exercise all the time when my kids are screaming and fighting! Or once you're working as a nurse and you have a difficult patient or a difficult shift, try the mindfulness exercises and some good breathing skills and know that you will be ok.
About the Author: Lana Wilkins, MSN, BSN, RN

Lana Wilkins is a Registered Nurse with over 16 years of professional nursing. She is a nursing educator, consultant, Subject Matter Expert, and writer with a passion for helping students and new nurses. She holds a B.S. in Nursing from the University of Oklahoma and a M.S. in Nursing Education from Western Governors University. Outside of the world of nursing she can be found managing the chaos of 2 kids, a husband, and a cat, being crafty, or spending time with friends.

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