We show
our work.
See where questions start, which checks run before practice, how difficulty changes, and what those checks cannot guarantee.
4 learning science principles · 26learning categories · 289sub-topics · automated quality checks
It starts with
the science.
The practice flow uses four learning principles. The references below explain the evidence and the limits of each one.
- Retrieval practice
- Pulling answers from memory strengthens retention far more than re-reading notes. Every Lily session is active recall, not passive review.
- Roediger & Karpicke, 2006↗
- Spaced review
- Concepts resurface at increasing intervals based on how well you know them. The harder something is to recall, the more reviewing it strengthens the memory.
- Cepeda et al., 2006↗
- Interleaving
- Mixing topics within a session improves your ability to transfer knowledge to new clinical scenarios. No more studying one topic in isolation until you feel ready.
- Rohrer & Taylor, 2007↗
- Desirable difficulty
- Questions that feel appropriately hard produce deeper, longer-lasting learning. Easy questions feel good but do not grow your skills.
- Bjork & Bjork, 2011↗
Organized around the
2026 NCLEX® test plan.
We read the same test plan your testing center uses. Every question maps to the 2026 NCSBN RN Test Plan or the 2026 NCSBN PN Test Plan, depending on the exam you choose. Your practice mirrors the actual exam structure either way.
Client Needs Categories
Safe and Effective Care Environment
Management of Care, Safety and Infection Prevention and Control
Health Promotion and Maintenance
Health Promotion and Maintenance
Psychosocial Integrity
Psychosocial Integrity
Physiological Integrity
Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, Physiological Adaptation
See the full 2026 test plan map with official scoring ranges →
Learning Topics
26 categories · 289 sub-topics tracked
- Heart Failure & Cardiac Output
- Coronary Artery Disease & Angina
- Dysrhythmias & ECG Interpretation
- Hypertension & Vascular Disorders
- Peripheral Vascular Disease & Venous Thromboembolism
- Shock & Hemodynamic Monitoring
- Valvular Disorders & Cardiac Surgery
- Cardiac Catheterization & Pacing Devices
- Infective Endocarditis & Cardiac Inflammatory Disorders
- Aortic Aneurysm & Aortic Dissection
- Cardiac Tamponade & Pericarditis
- Chronic Obstructive Pulmonary Disease (COPD)
- Asthma & Reactive Airway Disease
- Pneumonia & Respiratory Infections
- Mechanical Ventilation & Airway Management
- Oxygen Therapy & Delivery Devices
- Chest Tubes & Thoracic Surgery
- Pulmonary Embolism & Venous Thromboembolism
- Tuberculosis & Respiratory Isolation
- Respiratory Assessment & Pulmonary Hygiene
- Acute Respiratory Distress Syndrome (ARDS)
- Lung Cancer & Thoracic Malignancies
- Sleep Apnea & Sleep-Disordered Breathing
- Cystic Fibrosis & Bronchiectasis
- Stroke (CVA) & Transient Ischemic Attack
- Seizures & Epilepsy
- Traumatic Brain Injury & Increased ICP
- Spinal Cord Injury & Neurogenic Shock
- Meningitis
- Encephalitis
- Multiple Sclerosis & Neurodegenerative Disorders
- Parkinson's Disease & Movement Disorders
- Neurological Assessment & Cranial Nerves
- Myasthenia Gravis & Neuromuscular Junction Disorders
- Trigeminal Neuralgia & Peripheral Neuropathy
- Guillain-Barre Syndrome
- Liver Disease & Hepatitis
- Peptic Ulcer Disease & Gastritis
- Inflammatory Bowel Disease & Bowel Disorders
- Bowel Obstruction & Abdominal Emergencies
- Pancreatitis
- Gallbladder Disease & Cholecystitis
- GI Bleeding & Upper/Lower GI Disorders
- Nutrition & Enteral/Tube Feeding
- Ostomy Care & Bowel Elimination
- GERD & Esophageal Disorders
- Appendicitis & Peritonitis
- Cirrhosis Complications (Encephalopathy, Varices, Ascites)
- Acute Kidney Injury & Renal Failure
- Chronic Kidney Disease & ESRD
- Dialysis & Renal Replacement Therapy
- Urinary Tract Infections & Pyelonephritis
- Urinary Catheterization & Bladder Management
- Renal Calculi & Urological Procedures
- Fluid Balance & Urine Output Monitoring
- Glomerulonephritis & Nephrotic/Nephritic Syndrome
- Benign Prostatic Hyperplasia & Urinary Retention
- Diabetes Mellitus Type 1
- Diabetes Mellitus Type 2
- Thyroid Disorders & Thyroid Storm
- Cushing's Syndrome & Hypercortisolism
- Addison's Disease & Adrenal Insufficiency
- SIADH & Fluid Retention
- Diabetes Insipidus
- Diabetic Ketoacidosis (DKA)
- Hyperosmolar Hyperglycemic State (HHS)
- Insulin & Oral Hypoglycemic Administration
- Hypoparathyroidism
- Hyperparathyroidism
- Metabolic Syndrome & Endocrine Assessment
- Pheochromocytoma & Adrenal Tumors
- Fractures & Cast/Splint Care
- Joint Replacement & Orthopedic Surgery
- Osteoporosis & Bone Health
- Traction & Immobilization Devices
- Compartment Syndrome & Neurovascular Assessment
- Rheumatoid Arthritis & Autoimmune Musculoskeletal
- Amputation & Prosthetic Care
- Osteomyelitis & Bone Infections
- Low Back Pain & Spinal Disorders
- Gout & Crystal Arthropathies
- Wound Care & Wound Healing Stages
- Burns & Burn Classification
- Pressure Injuries & Prevention
- Skin Assessment & Lesion Identification
- Surgical Site Management & Wound Drains
- Skin Infections & Dermatological Conditions
- Skin Cancer & Melanoma Assessment
- Latex Allergy & Contact Dermatitis
- Wound Irrigation & Debridement Methods
- Antepartum Care & Prenatal Assessment
- Intrapartum & Labor Management
- Postpartum Care & Complications
- Newborn Assessment & Adaptation
- High-Risk Pregnancy & Complications
- Fetal Monitoring & Diagnostic Tests
- Breastfeeding & Newborn Nutrition
- Gestational Diabetes & Hypertensive Disorders of Pregnancy
- Postpartum Contraception & Reproductive Planning
- Neonatal Complications & NICU Nursing
- Preterm Labor & Tocolytic Therapy
- TORCH Infections & Perinatal Infections
- Growth & Development Milestones
- Pediatric Respiratory Disorders
- Pediatric Cardiac Conditions
- Childhood Infectious Diseases
- Pediatric Pain Management & Assessment
- Pediatric Emergencies & Injury Prevention
- Pediatric GI & Metabolic Disorders
- Pediatric Neurological Conditions
- Pediatric Hematologic & Oncologic Conditions
- Pediatric Renal & Genitourinary Disorders
- Congenital Heart Defects (TOF, VSD, ASD, PDA)
- Child Development & Anticipatory Guidance
- Immunizations & Pediatric Vaccine Schedule
- Anxiety Disorders & Phobias
- Major Depressive Disorder
- Bipolar Disorder
- Schizophrenia & Psychotic Disorders
- Substance Use Disorders & Withdrawal
- Therapeutic Communication Techniques
- Crisis Intervention & Suicide Prevention
- Eating Disorders & Body Image
- Abuse & Neglect Recognition
- Personality Disorders & Maladaptive Behaviors
- Trauma & Stressor-Related Disorders (PTSD)
- Cardiovascular & Antihypertensive Medications
- Anticoagulant Therapy
- Thrombolytic Therapy
- Antibiotics & Anti-infectives
- Psychotropic Medications
- Diabetic & Endocrine Medications
- Respiratory & Bronchodilator Medications
- Immunosuppressants & Biologic Therapies
- Adverse Effects of Cardiovascular Medications
- Adverse Effects of Anticoagulants & Thrombolytics
- Adverse Effects of Antibiotics & Anti-infectives
- Adverse Effects of Psychotropic Medications
- Adverse Effects of Diabetic & Endocrine Medications
- Adverse Effects of Respiratory Medications
- Adverse Effects of Immunosuppressants
- Adverse Effects of Opioids & Analgesics
- Drug Contraindications & Allergy Recognition
- Drug-Drug Interactions
- Medication Administration Safety & Rights
- High-Risk & High-Alert Medications
- Parenteral & IV Therapies
- Pharmacological Pain Management
- Blood Product Administration
- Total Parenteral Nutrition (TPN)
- Medication Reconciliation
- Client Education on Medications
- Dosage Calculations & Safe Dose Ranges
- Controlled Substances & Regulatory Guidelines
- Diuretics & Electrolyte Monitoring
- Neurological Medications (Anticonvulsants, Parkinson's, Alzheimer's)
- Corticosteroids & Adrenal Suppression
- GI Medications (PPIs, Antiemetics, Laxatives)
- Antifungals & Antivirals
- Thyroid Medications (Levothyroxine, Methimazole)
- Muscle Relaxants & Skeletal Medications
- Anesthetics, Sedatives & Reversal Agents
- Ophthalmic & Otic Medications
- Herbal Supplements & OTC Interactions
- Standard & Universal Precautions
- Transmission-Based Precautions (Airborne/Droplet/Contact)
- Surgical Asepsis & Sterile Technique
- Healthcare-Associated Infections
- Hand Hygiene & PPE
- Isolation Procedures & Immunocompromised Clients
- Multidrug-Resistant Organisms (MRSA, VRE, C. diff)
- Needlestick Injury & Bloodborne Pathogen Exposure
- Sepsis & Systemic Inflammatory Response Syndrome (SIRS)
- Hyponatremia
- Hypernatremia
- Hypokalemia
- Hyperkalemia
- Hypocalcemia
- Hypercalcemia
- Hypomagnesemia
- Hypermagnesemia
- Acid-Base Balance & ABG Interpretation
- IV Therapy & Fluid Replacement
- Dehydration & Fluid Volume Overload
- Phosphorus & Chloride Imbalances
- Fluid Spacing & Third-Space Fluid Shifts
- Anemia & Blood Disorders
- Leukemia
- Lymphoma
- Cancer Nursing & Oncologic Emergencies
- Chemotherapy Side Effects & Management
- Radiation Therapy Side Effects & Management
- Blood Transfusion Reactions & Administration
- Bone Marrow Transplant & Immunosuppression
- Tumor Lysis Syndrome & Disseminated Intravascular Coagulation
- Sickle Cell Disease & Hemoglobinopathies
- Coagulation Disorders & Thrombocytopenia
- Polycythemia Vera & Myeloproliferative Disorders
- HIV/AIDS & Opportunistic Infections
- Systemic Lupus Erythematosus (SLE)
- Rheumatoid Arthritis
- Anaphylaxis & Allergic Reactions
- Organ Transplant & Rejection
- Immunodeficiency Disorders
- Immunizations & Vaccine Administration
- Hypersensitivity Reactions (Type I-IV)
- Sexually Transmitted Infections
- Contraception & Family Planning
- Menopause & Hormonal Changes
- Prostate & Testicular Disorders
- Breast & Cervical Cancer Screening
- Sexual Health Assessment & Education
- Infertility & Assisted Reproduction
- Gynecological Disorders & Surgical Interventions
- Delegation & Assignment Making
- Prioritization & Triage
- Informed Consent & Advance Directives
- Quality Improvement & Evidence-Based Practice
- Scope of Practice & Chain of Command
- Patient Advocacy & Rights
- Interprofessional Collaboration
- Restraint Use & Safety Devices
- Incident Reporting & Error Prevention
- Continuity of Care & Discharge Planning
- Staffing, Nurse-to-Patient Ratios & Unsafe Assignments
- Advance Directives, DNR & Goals of Care Conversations
- Therapeutic Communication in Nursing Practice
- Nonverbal Communication & Active Listening
- Documentation & Clinical Reporting
- Nursing Informatics & Health Technology
- Nursing Process (Assessment, Diagnosis, Planning, Implementation, Evaluation)
- Patient Education & Health Literacy
- Cultural Competence & Diversity in Care
- Ethical & Legal Nursing Practice
- SBAR & Interprofessional Handoff Communication
- Clinical Judgment & Critical Thinking
- Professional Nursing Practice & Standards
- Safety & Infection Prevention Basics
- Glaucoma & Intraocular Pressure
- Cataracts & Lens Disorders
- Macular Degeneration & Retinal Disorders
- Hearing Loss & Hearing Aids
- Meniere's Disease & Vestibular Disorders
- Eye Injury & Emergency Eye Care
- Otitis Media & Ear Infections
- Retinal Detachment & Vitreous Disorders
- Conjunctivitis & External Eye Conditions
- Otosclerosis & Stapedectomy
- Sensory Assessment & Cranial Nerves
- Assistive Devices & Sensory Communication
- Diabetic Retinopathy
- Tinnitus Management
- Dementia & Alzheimer's Care
- Polypharmacy & Medication Reconciliation
- Falls Prevention & Mobility Safety
- Elder Abuse Recognition & Reporting
- Age-Related Physiological Changes
- End-of-Life Care & Palliative Nursing
- Delirium vs. Dementia Differential
- Sensory Changes & Social Isolation in Aging
- Triage Systems & Emergency Prioritization
- Basic Life Support (BLS)
- Advanced Cardiac Life Support (ACLS)
- Disaster Preparedness & Response
- Trauma Assessment & Stabilization
- Emergency Medications & Rapid Response
- Mass Casualty Incident Management
- Poisoning & Toxicological Emergencies
- Environmental Emergencies
- Macronutrients & Energy Balance
- Vitamins & Minerals
- Therapeutic Diets & Medical Nutrition Therapy
- Nutritional Assessment & Screening
- Metabolism & Biochemistry
- Physical Examination Techniques
- Health History & Patient Interview
- Vital Signs & Baseline Data
- Diagnostic Reasoning & Clinical Findings
- Documentation & Communication
- Study Design & Methodology
- Biostatistics & Data Interpretation
- Evidence-Based Practice Models
- Ethical Research Principles
- Literature Review & Critical Appraisal
- Bioethics & Ethical Decision-Making
- Healthcare Law & Regulation
- Health Disparities & Social Determinants
- Patient Rights & Advocacy
- Healthcare Systems & Policy
Source: 2026 NCSBN RN Test Plan
Taking the NCLEX-PN®?
The PN exam has its own plan. We follow that one too.
The 2026 NCSBN PN Test Plan keeps the same four Client Needs categories but reflects the practical nurse scope. Management of Care becomes Coordinated Care, and Pharmacological and Parenteral Therapies becomes Pharmacological Therapies. We frame your questions the PN way: data collection, reinforcing teaching, and assisting with the care plan under RN or provider direction.
Clinical Judgment,
not a checkbox.
The NCSBN's Clinical Judgment Measurement Model has 6 steps. Supported question formats practice different steps, while unfolding cases move through them across multiple phases.
Assessment
Reasoning
Action
Single Best Answer (SBA) and Select All That Apply (SATA) test recall, comprehension, and application across the clinical judgment spectrum.
BowTie items exercise all 6 CJMM steps in a single question. You identify the condition, choose nursing actions, and select monitoring parameters with realistic differential diagnoses as distractors.
Unfolding Case Studies present a patient scenario that evolves over multiple phases. You assess, intervene, and reassess as the clinical picture changes, just like real practice.
As NCSBN expands Next Gen item types, Lily will add them with the same validation and adaptive difficulty. More formats coming soon.
How each question
is built.
Questions start from a nursing concept, an NCLEX® test plan target, or a relevant excerpt from uploaded course material.
NCLEX® questions receive a body-system, nursing-process, and Client Needs classification. Difficulty maps to Bloom's Taxonomy. Question targets include assessment, intervention, medication, delegation, and prioritization.
Questions are not served raw. Lily runs nursing-specific quality gates for format, answer structure, rationale coverage, NCLEX® classification, duplicate scenarios, and unsafe clinical answer patterns before questions reach practice. Coursework questions keep the supporting source attached, so you can compare each rationale with your uploaded material.
Questions that fail required structure or safety checks are rejected before they enter practice. Study With Lily is built for exam preparation, not patient-care decisions. Confirm clinical guidance with current authoritative sources.
Current pipeline
Automated quality checks.
The checks below cover structure, rationales, classification, duplication, and clinical safety rules.
Option counts and NGN structure
Required correct-answer count by format
Whole-item and per-option explanations required
Client Needs and nursing topic fields
Near-identical stems rejected
Unsafe scope and medication answers rejected
Under the hood
A concept map of the entire test plan.
Our newest questions start from a map, not a blank page. We took the NCSBN test plan apart and rebuilt it as thousands of connected nursing concepts: every Client Needs category, the topics inside it, and the specific rules a safe nurse has to know. RN and PN each get their own map, built from their own test plan.
We anchor every new question to one point on that map before we write a single word. It knows which category it belongs to, which concept it tests, and which concepts it builds on. The map also shows where coverage is thin. So new questions grow where NCSBN's published distribution chart says they should, not where they are easiest to write.
Then they adapt
to you.
Once a question is built and validated, Lily decides when and how to show it to you.
Difficulty Scaling
Get 3 out of 4 right? The next question gets harder. Struggling? It scales back. Difficulty maps to Bloom's Taxonomy.
Weak Topic Resurfacing
Drop below this in any topic and it comes back more often. The topic returns in later sessions until your performance improves.
Concept-Level Tracking
Lily records results by concept, not only by question. Each concept has its own review schedule. Higher-scoring concepts come back less often. Struggling concepts come back sooner and from different angles.
Rationales for
each answer.
Each rationale explains the keyed answer, the clinical reasoning, and why the other options do not fit.
Overall rationale. A paragraph explaining the correct answer, the clinical reasoning, and why it matters.
Option-level explanations. Each wrong answer is explained too. Why it is a common misconception, where it would apply differently, and how it differs from the correct choice.
Source traceability. NCLEX® questions carry topic classifications. Coursework questions show the supporting excerpt from the uploaded material.
Your materials,
same methodology.
Everything above applies to NCLEX® practice. Lily also builds practice from your own class material. Upload your syllabus, lecture slides, or study guide, and the same methodology builds practice questions from your professor's content. PDFs, slide decks, Word docs, images, and text files are all supported.
Lily identifies topics in the uploaded material and links each Coursework question to a supporting excerpt. The same format, answer-key, rationale, classification, and duplication checks run before the question enters practice.
Learn more about coursework practiceFor Nursing Educators
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Study With Lily is an independent study tool. NCLEX® is a registered trademark of the National Council of State Boards of Nursing (NCSBN®). Study With Lily is not affiliated with or endorsed by NCSBN. Questions are original practice items and are not derived from actual NCLEX® exam content. Study With Lily is built for exam preparation, not patient-care decisions. Confirm clinical guidance with current authoritative sources.