8 Steps Of NCLEX Question Analysis | Joyce - Ameritech College

1. Understanding the NCLEX Question Format

There’s no point in denying it — NCLEX questions can be confusing. Many test takers with great nursing knowledge and instincts slip up by misreading the exam. Avoid this pitfall by breaking down NCLEX questions to understand their format and phrasing. When you get to the core of what they’re asking, you can let your nursing knowledge shine.

Multiple Choice NCLEX Questions

The majority of NCLEX questions are multiple choice and formatted with a stem and several answers. The stem lays out the nursing scenario and asks a question. It can be a short sentence or more detailed, with up to a paragraph of information. The answers are the multiple choice options. When you’re reading a multiple choice NCLEX question, read through the stem and pay close attention to whether it is a positive, negative, or priority question.

A. Positive questions ask you to identify the one correct answer. Positive questions are the most straightforward and often include keywords like the following:

• appropriate
• true
• correct
• indicated

B. Negative questions ask you to identify a false answer. The wording on negative questions can be hard to catch because the test rarely says something as clear as “the following are true except…” Keep an eye out for words and phrases that indicate that a qualified nurse would step in, stop a student from performing certain actions, or would teach a student more. Some words to look out for in the question stem are:

• avoid
• contraindicated
• not/never
• least
• further education
• refute
• negate

C. Priority questions ask you to choose which answer from several correct options is the most important, most correct, or should occur first. Keywords that indicate a priority question include:

• most appropriate
• best
• first
• priority
• primary
• initial

Read more about how to answer NCLEX priority questions, and check out this blog post for more multiple choice tips and strategies.

Alternate Format NCLEX Questions

The NCLEX uses an adaptive learning model to administer the exam which means everyone gets a slightly different mix of NCLEX questions, but you can expect that you’ll encounter some that aren’t formatted as multiple choice. These are called alternate format NCLEX questions. Below are a few of the different types of alternate-format questions you can expect to encounter:

• Audio Questions — You’ll listen to an audio clip and answer a question about it. Be familiar with normal heart, lung, and bowel sounds to prepare for audio format NCLEX questions.
• Chart/Exhibit Questions — You’ll be presented with a medical chart or exhibit that provides context for anything from one multiple choice question to six alternate format questions. Pay attention to all the details and look for clues that will help you answer correctly.
• Graphic Questions — Graphic questions consist of a question with images as the answers. You’ll click an image instead of selecting from written options. For example, you may see four heart rhythm images and have to click on the image that would be shockable.
• Hot Spot Questions — These questions often show an image of a body part or a scan. You’ll click on an area of the image or scan that’s indicated in the question’s scenario. For example, you may be presented with an image of a lung scan and asked to identify the location of an abnormality by clicking on that part of the image.
• Multiple Response Questions (aka Select all that apply or SATA)— Unlike multiple choice questions where you only select the single best answer, on multiple response questions, you’ll be asked to select every answer that applies. One way you can assess this kind of question is to consider each option independently and evaluate each option as a true or false question.
• Ordered Response Questions — Ordered response questions require you to drag and drop answer options into the correct sequence. These can also be used to rank options by priority. For example, would you first give oxygen to a client who has shortness of breath or sit them up in bed.
• Fill In the Blank Questions — Fill in the blank questions are usually reserved for calculations, and don’t worry, you will have a calculator available to you during the NCLEX. You’ll type an answer directly into the answer box.
• Bowtie Questions — The Bowtie Question on the NCLEX-RN is a type of multiple-choice question that presents a clinical scenario and asks test takers to identify the most critical nursing intervention to prevent a potential adverse event while also considering the possible consequences of various choices.

The same close reading and critical thinking skills you’ll use for multiple choice apply to alternate format questions. Check out this blog post for more information on alternate format NCLEX questions.