F E A T U R E A R T I C L E Laying the Groundwork for NCLEX Success An Exploration of Adaptive Quizzing as an Examination Preparation Method REBECCA A. COX-DAVENPORT, PhD, RN JULIA C. PHELAN, PhD LITERATURE REVIEW Nursing school graduates must pass the NCLEX-RN (hence- forth referred to as the NCLEX) before they become a licensed RN. Many nursing accrediting bodies include first- time NCLEX pass rate of program graduates in the ac- creditation process. 1,2 The percentage of students passing the NCLEX the first time has consequently emerged as one indicator of a successful and high-quality nursing pro- gram. A nursing school’s first-time NCLEX pass rate is also used by state boards of nursing and the nursing school’s community of interest as an indicator of graduate quality. 2,3 Progression Policies Pressure to both increase and maintain NCLEX pass rates has led many schools to implement progression policies linked to standardized examination scores. Many nursing programs try to predict student success with the use of standardized assessments such as those provided by the ATI and HESI testing programs. 4,5 According to the National League for Nursing (NLN), 2 one in five pre- licensure nursing schools uses a minimum score on a stan- dardized examination to allow students to graduate from the nursing program. The NLN also reports as many as one-third of nursing schools use standardized testing in the progression of students and 12% of schools will not forward students’ names for state board examination reg- istration unless a minimum threshold on a standardized measure is reached. Spurlock 6 indicated a paucity of guid- ance for faculty in how best to interpret scores from stan- dardized tests as well as how to set minimum thresholds for progression or graduation policies. And—when standardized tests are used to preclude graduation or progression—the pool of students permitted to take the NCLEX is not necessarily a valid representation of the student population as a whole. Such practices result in a 208 CIN: Computers, Informatics, Nursing & May 2015 CIN: Computers, Informatics, Nursing & Vol. 33, No. 5, 208–215 & Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved. First-time NCLEX-RN pass rates are an important indicator of nursing school success and quality. Nursing schools use different methods to antici- pate NCLEX outcomes and help prevent student failure and possible threat to accreditation. This study evaluated the impact of a shift in NCLEX prep- aration policy at a BSN program in the southeast United States. The policy shifted from the use of predictor score thresholds to determine graduation eligibility to a more proactive remediation strategy involving adaptive quizzing. A descriptive correla- tional design evaluated the impact of an adaptive quizzing system designed to give students ongo- ing active practice and feedback and explored the relationship between predictor examinations and NCLEX success. Data from student usage of the system as well as scores on predictor tests were collected for three student cohorts. Results re- vealed a positive correlation between adaptive quizzing system usage and content mastery. Two of the 69 students in the sample did not pass the NCLEX. With so few students failing the NCLEX, predictability of any course variables could not be determined. The power of predictor examinations to predict NCLEX failure could also not be sup- ported. The most consistent factor among students, however, was their content mastery level within the adaptive quizzing system. Implications of these findings are discussed. KEY WORDS Adaptive quizzing & High-stakes testing & Predictor examinations Author Affiliations: College of Nursing, Lander University, Greenwood, SC (Dr Cox-Davenport); and UCLA/CRESST, Los Angeles, CA (Dr Phelan). The authors have disclosed that they have no significant relation- ship with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Rebecca A. Cox-Davenport, PhD, RN, 320 Stanley Ave, Barratt Hall, Greenwood, SC (rcoxdavenport@lander.edu). DOI: 10.1097/CIN.0000000000000140 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.