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The NLN-PAX ({YEAR} Guide)

The NLN-PAX (2023 Guide)

The NLN-PAX is a nursing exam that is specially used by nursing schools to assess whether a candidate has the skills and aptitude to be successful within the role they are applying for.

'PAX' stands for Pre-Admission Exam and was created by the National League for Nursing – which is the 'NLN' at the front.

A nursing school might use the PAX to speed up the recruitment process and ensure they only allow candidates possessing the skills and cognitive abilities they are looking for.

Just scoring high in the exam is not reason enough to get in; however, it does help to get you through to the next stages of the interview process.

This article will explain exactly what the NLN-PAX is, how it is administered and will give some sample questions for you to try.

What Is the NLN-PAX and Who Takes It?

NLN-PAX is an exam used by nursing schools during the interview process.

It is taken by prospective registered nurses and practical nurses before they start their training.

A low score can potentially hinder a nurse’s chance of being admitted into a nursing school.

The test is timed and features multiple-choice questions in three areas – math, science and verbal ability.

Nursing students will also be given the same test, for which the results will be given to their colleges.

The specifics of the NLN-PAX test itself and the score required will be determined by each test center and can be higher or lower depending on the requirements.

The pass mark for the NLN-PAX is standardized but some schools might require their applicants to obtain a higher score to make it to the next stage.

The NLN-PAX is fast-paced, challenging and complex. However, if you are fully prepared before you take it, you should not worry too much.

The NLN-PAX can be taken up to three times per year. It costs $60–$100 to take, depending on where you take it.

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How Long Do You Have to Take the NLN-PAX Test?

Everyone has 2 hours and 5 minutes total to take the test, with the time being separated for each section:

  • Verbal – 45 mins
  • Science – 45 mins
  • Math – 35 mins

Keep these timings in mind when you are taking some practice tests – after you are used to the format of the questions, work under time pressure to become familiar with how fast you need to go.

How Do You Register for the NLN-PAX?

The NLN-PAX registration will be done through the school you are applying for. There are several test times each month, so it is best to contact your chosen school to secure a date.

The start times can differ depending on the location where you wish to take the exam, so it is good to check their website or contact the location via phone.

Make sure you pick the date and time that suits you best – a time in the day when you are most productive will be more beneficial.

The test is valid for three years and can be taken three times within 12 months. So, as mentioned above, if you fail the first time, you have another two attempts within that year to re-take the test.

What Is Being Assessed the NLN-PAX Test?

The NLN-PAX assesses the following abilities:

  • Verbal
  • Scientific
  • Mathematical

Here is a little bit more information about each proficiency:


The verbal part of the NLN-PAX assessment contains 60 questions with 45 minutes to answer and comprises questions from grammar and vocabulary to verbal reasoning, which tests your critical thinking.

The questions will vary from comprehension to language and their subjects might not even be related to nursing.

Each question is multiple-choice.

The reading comprehension questions will provide you with a text to read and a range of multiple-choice questions regarding it – you will need to read the passage thoroughly before you select your answer.

You should take around 45 seconds to answer each question, including the time you will need to read the text.


This NLN-PAX section covers a wide variety of different topics relating to science, such as first aid, health, anatomy and even general biology questions.

Some exams might even feature questions on physics and climate change, so it is important to do your homework to cover all bases before the exam.

It is important to show knowledge, skills and efficiencies that go beyond nursing to express how well you pick up new information, retain it and put it to good use.

You will have 45 minutes to complete 60 questions within this area, which works out to be around 45 seconds per question on average, although some questions might take a longer or shorter amount of time to answer.


The math section of NLN-PAX covers questions from algebra and geometry to fractions and problem-solving equations.

It would be good to know how to convert between decimals, fractions and percentages, and how to interpret data from charts – among other things.

You will have 35 minutes to complete the 40 questions of the math section of the NLN-PAX, which is around 50 seconds per question.

As you cannot use a calculator you must get used to working out mathematical equations by hand.

This is something you can practice when you start preparing for the exam.

It is also good to time yourself to see how quickly you can answer these questions without help from a calculator and working under pressure.

Here are some free guides on general numerical reasoning and fractions, free practice tests on numerical reasoning, computation, estimation and data interpretation, and a more extensive paid-for 127-page guide to numerical reasoning.

You could also consider getting a tutor for a short time to refresh your memory and skill set.

What to Expect When Taking NLN-PAX – Sample Questions

Here are some questions that are like those you could receive on the NLN-PAX:

Verbal Skills Sample Questions


Example Question

Select the word most different in meaning from the other words in the list below:

a) sad
b) happy
c) distant
d) morose


Example Question

Read this extract about the history of nursing and answer the question below:

’Although there were famous early nurses such as Florence Nightingale and Mary Seacole (the former opening her own training school in 1860), hospitals didn't widely recruit and train nurses until the 1900s and early nursing was seen as an undesirable profession.

'The two world wars contributed greatly to the profession's image, status and popularity, thousands of nurses were recruited and many gained officer status in World War 2.

'Nursing is now seen as a desirable career for all and is being given the status it deserves, most nursing qualifications having become degree level in the 2000s.'

Why was this article put together?

a) To learn about how the nursing profession has developed
b) To make people not want to become a nurse
c) To recruit nurses into the NHS
d) To explore the development of the health system

Mathematics Sample Questions

Example Question

What is 49 multiplied by 18?

a) 927
b) 882
c) 87
d) 675

Here is another one for you to try:

Example Question

Sarah has $36 on hand and bought lunch worth $11.47. How much money does she have remaining?

a) $24.53
b) $25.99
c) $18.32
d) $21.58

Science Example Questions

Example Question

A woman weighs 195 lbs. What is her weight in kgs?

a) 88.45 kg
b) 88.46 kg
c) 87.50 kg
d) 88.35 kg

Example Question

You are in Los Angeles and it is 4 a.m. You are talking to a friend in Dublin, Ireland – he tells you it is noon; how many degrees separate Los Angeles from Dublin?

a) 130 degrees
b) 120 degrees
c) 140 degrees
d) 80 degrees

For science, you might also be asked a question about physics, time and space – so ensure you revise all areas before taking the exam.

How Is the NLN-PAX Test Scored?

The maximum score for the NLN-PAX is 200, with an average of 100, plus or minus 20 (the standard deviation).

Your NLN-PAX scorecard will present your composite score – the total amount of questions you got correct – as well as percentage correct per section (for example, 60% correct in the verbal section, 45% correct in the math section and 65% in the science section).

These are then converted into percentiles based on the average spread of scores in each section (for example, 60% correct in the science section may equate to a percentile score of 77).

Percentiles indicate the number of people who took the test and got less than that score.

A table is given to convert your overall composite score into a percentile.

A test score of between 199 and 145 overall will land you in the 99% percentile – more than two standard deviations above the average. 99% of people score less than 145.

A score of 117 equates to the 70% percentile. 70% of people score less than 117.

You must complete all three sections to pass the NLN-PAX. The NLN-PAX pass level varies from school to school – most require you to score 100+; in order words, you should have a composite percentile of 50.

How to Prepare for NLN-PAX Test

Preparing for the NLN-PAX (National League for Nursing Pre-Admission Examination) can help you improve your performance on the test.

Here are some tips to help you prepare:

Understand the test format

Familiarize yourself with the structure and content of the NLN-PAX.

The test consists of three main sections: verbal skills, math and science.

Understanding the format and question types will help you know what to expect on test day.

Review relevant content

Take the time to review and refresh your knowledge in key subject areas.

Brush up on grammar and vocabulary for the verbal skills section, review math concepts including algebra, geometry and basic arithmetic, and cover key topics in science such as biology, chemistry and physics.

Practice sample questions and practice tests

Utilize NLN-PAX practice materials and sample questions to familiarize yourself with the types of questions you may encounter.

This will help you become more comfortable with the test format and improve your speed and accuracy.

Taking full-length practice tests can simulate the actual testing experience and help you gauge your progress.

Analyze your performance, identify areas of strength and weakness and adjust your study focus accordingly.

Create a study schedule

Develop a study schedule that allocates time for each section of the NLN-PAX.

Set aside dedicated study time for verbal skills, math and science.

Breaking down your study sessions into smaller, focused blocks can be more effective than cramming all at once.

Use study guides and resources

Seek out NLN-PAX study guides and other educational resources to supplement your preparation.

These resources often provide comprehensive content review, practice questions and test-taking strategies specific to the NLN-PAX.

Seek out tutoring or prep courses

Consider enrolling in a tutoring program or NLN-PAX prep course if you prefer additional guidance and support.

These resources can provide expert instruction, personalized feedback and targeted strategies to help you improve your performance.

Practice time management

The NLN-PAX is a timed test, so practice managing your time effectively.

During your practice sessions, set timers to simulate the test conditions and practice pacing yourself to complete each section within the allotted time.

Review and learn from mistakes

Analyze any mistakes you make during practice sessions.

Understand the concepts behind the questions you missed and seek clarification on those topics.

Use your mistakes as learning opportunities to improve your understanding and performance.

Get sufficient rest and manage test anxiety

Ensure you get enough sleep the night before the test and maintain a healthy lifestyle leading up to test day.

Manage test anxiety by practicing relaxation techniques, deep breathing exercises and positive self-talk to stay calm and focused during the test.

How to Ace the NLN-PAX in 2023

If you are not sure how you will pass the test, here are a few suggestions to help get you started:

Step 1. Make Sure You Have Enough Time to Prepare for the Test

Research is key and the more you know and practice, the more confident you will feel when taking the test.

Try not to rush and/or cram – revising over a longer period of weeks means the information will be more strongly embedded in your memory.

Step 2. Take Practice Tests

Taking several practice tests is probably the best thing you can do to prepare for the test. You will be able to get a better idea of how the test is formatted and how much time it takes you to answer each question.

Step 3. Visit Your Test Center

If you are not taking the test online (currently common practice due to the COVID-19 pandemic), you should familiarize yourself with the location of the test center, ideally visiting it before the test day so you do not get lost on the way there.

Step 4. Do Online Practice Sessions

There are plenty of resources to help you out through live video call sessions. The NLN offers a Readiness Review 1-Day session to help you find out if you are ready for the PAX. You can also buy practice materials and other study aids.

Step 5. Look After Yourself

This should go without saying, but the more relaxed your mind is and the more you take care of your body, the better your cognitive abilities will react to the test.

Final Thoughts

There are plenty of tools out there to help you prepare for the NLN-PAX exam, so do not worry too much before you take the test.

If you do not score satisfactorily, you can always try again.

Just always remember preparation is key.

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