Updated 23 June 2021
The NLN-PAX 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 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 is standardized but some schools might require their applicants to obtain a higher score to make it to the next stage.
The test 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.
How Long Do You Have to Take the 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 assesses the following abilities:
Here is a little bit more information about each proficiency:
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 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 does not allow the use of a calculator and 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.
Sometimes math can be difficult for students that might not have finished high school or are not that confident in their mathematical abilities. But it does play quite a big role in this exam, so brushing up on your skills is definitely worth the investment.
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:
Select the word most different in meaning from the other words in the list below:
Answer: b) happy
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
What is 49 multiplied by 18?
Answer: b) 882
A quick way to work this one out would be to multiply 18 by 50 (18 x 5 = 90, 90 x 10 = 900) then minus 18 (900 – 18 = 882).
Here is another one for you to try:
Sarah has $36 on hand and bought lunch worth $11.47. How much money does she have remaining?
Answer: a) $24.53
This example is a good reminder to read the whole question and possible answers thoroughly – initially, 36 minus 11.47 can seem overwhelming to do in ~30 seconds, but a closer examination of the answers reveals only one of them ends in 3 and so must be correct.
Science Example Questions
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
Answer: 88.45 kg
Unlike the second math question above, this one does not have an easy answer hidden in plain sight. For this question, you need to be able to convert lbs to kg – do not forget to practice your units.
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
Answer: b) 120 degrees
There are 8 hours difference between LA and Dublin – the difference between 4 a.m. and 12 p.m. (noon). 60 minutes difference in time zone equate to 15 degrees longitude, so you multiply 8 by 15 and get 120. This question requires you to use both math and knowledge about systems in the world.
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 Test Scored?
The maximum score for the NLN-PAX is 200, with an average of 100, plus or minus 20 (the standard deviation).
Your 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 pass level varies from school to school – most require you to score 100+; in order words, you should have a composite percentile of 50.
Key Tips for Success
If you are not sure how you will pass the test, here are a few suggestions to help get you started:
Time – 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.
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.
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.
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.
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.
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.