Test anxiety on NCLEX day: what the research says actually helps

Anxiety doesn't just feel bad. It competes for the same working memory you need to reason through a case study. The good news: some of the most effective fixes are simple and take minutes.

Write your worries down before the exam

In a study published in Science in January 2011, Gerardo Ramirez and Sian Beilock of the University of Chicago gave test-anxious students 10 minutes to write openly about their worries right before an exam. In one lab experiment, students who sat quietly lost about 12% accuracy under pressure, while students who wrote first improved by about 5%. In a ninth-grade biology class, highly anxious students who wrote before the final averaged a B+, versus a B− for anxious students who didn't. The researchers' explanation: writing "offloads" worries that would otherwise crowd working memory.

Reframe the racing heart

A fast heartbeat and sweaty palms aren't a sign you're about to fail. They're your body mobilizing energy. Research on stress reappraisal suggests that telling yourself "this arousal is helping me focus" can improve performance compared with trying to calm down.

Make the exam feel familiar

• Take at least one full-length, timed practice exam in the weeks before. The unknown is a big part of anxiety.
• Practice the actual formats (case studies, SATA) so nothing on screen looks new.
• Rehearse your break plan: when you'll stand up, drink water and breathe.

Know the exam-day rules so nothing surprises you

• Arrive at least 30 minutes early. Arriving more than 30 minutes late can mean losing your appointment and paying again.
• Bring ID that meets the requirements exactly. Without it you won't be admitted. You'll also give a signature, photo and palm vein scan.
• Five hours total, breaks included. Break time counts toward the five hours.
• You get tools. An on-screen calculator and an erasable note board with a marker are provided.
• Phones and devices are powered off and sealed in a plastic bag Pearson provides; coats, hats and scarves stay outside the testing room.

Sources: NCLEX exam day; optional breaks after about two and three and a half hours are described in the NCLEX Candidate Bulletin. Check both before your date, since rules can change.

The 24-hour routine

1. The day before: light review only, no new content. Confirm your ID, test center and travel time.
2. Sleep matters more than one more hour of questions.
3. Morning: eat something with protein, arrive early, do the 10-minute worry write.
4. During: if you freeze, take three slow breaths, reread only the question's last sentence, and eliminate options.
5. After: don't Google the question count. Rest. When results come and what Quick Results means are covered in NCLEX results: how long and how to check.