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NCLEX Wednesday #11 – Alternate Format Questions


When you study for the NCLEX, it’s all about questions—not just what they ask, but how they ask.

Last week’s NCLEX study tips offered strategies for multiple choice questions.

That’s the majority of what you’ll see on the National Council Licensure Examination, but you also need to prepare for the rest, which are Alternate Format type questions. These include:

  • Select All That Apply (also called Multiple Response)
  • Ordered Response
  • Fill-in-the-blank
  • Hot Spot
  • Exhibits/Chart
  • Graphic Options
  • Audio

Now, onto our NCLEX study tips to explain what all of those mean!

1. Select-All: Think “true or false”

The select-all type questions are pretty self-explanatory: They include more than one answer in the same question, usually with five possible options. When you read through them, it’s best to consider each answer as either true and false, with the true options being the correct answers. Here’s the tricky thing: With these types of questions, you get all or no points. No partial credit is given if you choose only some of the correct answers. That may seem daunting and even frustrating, so remember to take your time. Make sure to review several select-all questions as you study,so you’re familiar with and prepared for the format. Many students find these to be the most difficult questions, which means it can get easier from here.

2. Ordered Response: Order everything

Ordered response questions are those that require you to place the answer options in the correct order using the drag and drop method with the computer mouse. There’s nothing wrong here, but there is only one right order from start to finish. Whatever the scenario of the question, you’ll use all of the options and rank them in the correct order as directed.

3. Fill-in-the-Blank: Study up on your calculations

Fill-in-the-blank formats may seem intimidating, because you won’t have any answer in front of you, but with the right studying you’ll know exactly how to find it. These questions are often used for calculations of medication dosage, IV drip rates, intake and output, and due dates for pregnant women (using the first day of their last menstrual period as a guide). As long as you study and know how to do these and similar calculations, you’ll be fine.

4. Hot Spots: Pay attention to specific areas

Hot spot questions are often used with pictures of a body part. You’ll be asked to use the mouse to click on the specific area indicated in the question’s scenario. For instance, you may be asked the best place to auscultate the apical heart rate. You would then click on the correct place on the picture of the chest.

5. Exhibits/Chart: Remember how to interpret (and use) bedside charts

Exhibits/Chart questions include tabs that, when clicked on with the mouse, will give you more information about the client, similar to a bedside chart. There may be several tabs to open to reveal the information needed to answer the question. You’ll use this information to guide you toward the correct answer.

6. Graphic: Think in pictures, not words

Graphic questions use graphics (e.g., pictures, diagrams, heart rhythm tracings) instead of words as answer options. For instance, you may be asked to identify the heart rhythm that requires the most rapid action by the nurse, and would then choose from four different illustrations of rhythms. Or, you may be told that your laboring client is having back pain, so you would need to choose a picture of the best position to relieve this client’s pain.

7. Audio: Listen close for answer clues

Audio questions will require the use of headphones to listen to an audio clip of information. This may include heart sounds, lung sounds, or client speech patterns. You’ll then be asked to interpret what you hear or make a decision for care based on what you hear. Take your time, and listen closely. You’re allowed to replay the audio if needed.

P.S. We love feedback. Post to our Facebook page or give us a shout on Twitter with comments or requests for specific information you’d like to see in the series.

Happy studying, and see you with more NCLEX study tips next week!

– Cheryl Armstrong, MS, RN
– Britt Baer, RN, MSN-HCSM, SANE

For more NCLEX study strategies and advice, you can download our full NCLEX ebook here, for free!


About NCLEX Wednesday: AmeriTech’s NCLEX review course has helped our nursing students pass the NCLEX with flying colors. We’re spreading the love to all nursing students as part of a weekly series. Nurses unite!