Date Published: July 8, 2019
If you’ve started to prepare to take the NCLEX, you know just how overwhelming it can be. There are dozens of acronyms and terms used to describe the test that you’ve probably never heard of before… and that’s before you even begin studying!
One of the new terms that you will come across is alternate item format. While they may sound scary at first, alternate item formats are much easier to manage once you know exactly what you’re dealing with.
So, What Is an Alternate Item?
Alternate items are any items on the NCLEX that are not a standard multiple choice question. There are seven different alternate item formats that may be featured on the test, and there is no specific percentage or ratio of how many alternate items the NCLEX will present to a candidate. Since these items could pop up at any moment during the test, it is important to be prepared to answer them when you see them! Let’s take a look at each of the seven alternate item formats and how you can best prepare to tackle each one.
Multiple Response
Multiple response items are also sometimes referred to as “select all that apply” SATA items, and students say they tend to be one of the trickiest alternate item formats. These items present the candidate with a question and a list of possible responses where multiple answers may be correct, and you have to select all of the correct answers to get the question right. Multiple response items could only have one correct response, or every single one of the responses could be correct, so it’s easy to see why this type of question can overwhelm candidates!
How to tackle it: All of the possible answers to multiple response questions could be correct. Because of this, it’s best to isolate each response option and consider it on its own. Try approaching this item format with a true-false mindset: read the question, then read only the first response option and decide if that response correctly answers the question. If it does, mark it! Then, read the question again and move on to the next response option all by itself, as if it were an entirely separate item. By breaking the process up and using a true-false mindset, multiple response items seem much less intimidating.
Ordered Response
Ordered response items present candidates with a list of steps, tasks, or actions and require them to be put in a specific order. This item type tends to be another tricky one for candidates because, like multiple response items, you have to get all parts of the order correct to get the question right. The nice thing about ordered response questions, though, is that you will always use every piece that the question gives you.
How to tackle it: To put ordered response items in the correct sequence, it is important to think about basic priority rules. Consider the actions in terms of the nursing process and Maslow’s hierarchy of needs and ask yourself which step should take priority over the others using those models. Meeting the client’s basic physiological needs (ABC) and safety needs should come before anything else. You can refresh yourself of these four guidelines, here.
(P.S. These same tricks can help you to answer multiple-choice priority questions, as well!)
Fill in the Blank
Fill in the blank questions may also be called calculation questions, and require candidates to type in a numerical answer.
How to tackle it: The two most important things to pay attention to for fill in the blank questions are rounding and decimal points. Answers to calculation items should always be rounded at the end of the calculation, not during any of the steps in the middle. Decimal places, on the other hand, will vary from question to question. The item will specify if the final answer should be recorded as a whole number or have one or two decimal places. Remember to use a calculator and double check your answer!
Hot Spot
Hot spot items ask a candidate to identify a location on a graphic or table. These types of questions are often designed to test your knowledge of anatomy and physiology and how you would apply that knowledge to nursing practice.
How to tackle it: Hot spot questions are not designed to test how accurate you are with a mouse, so you don’t have to stress too much about marking an exact pixel on the graphic. However, it is very important to pay attention to details. Take note of any key words in the question that may help you to identify what part of the graphic or table to look at, and review all of that section thoroughly before selecting your answer. Another hint? You can also try finding the location on yourself, if feasible. Then, make sure you remember the client graphic is usually facing you.
Variations on Multiple-Choice Alternate Items
These last three alternate item formats are very similar to the standard multiple-choice questions that you will see on the NCLEX but are differentiated by how they present the information in the question and the possible answers.
Chart/Exhibit: Exhibit items require candidates to open a chart or other form of exhibit, review the information it contains, and use that information to select an answer from four multiple-choice options.
How to tackle it: Some exhibits may present you with multiple slides or pages of the information. It is important to review all parts of the exhibit before deciding which section of the chart the answer can be found on.
Added tip: The stem/question will tell you how many ‘exhibits’ there are and you are able to view each one as many times as needed before you choose your answer.
Graphic Answers: Graphic items are exactly the same as a standard multiple-choice question, but with graphics instead of text given for the four answer options.
How to tackle it: Just like exhibit questions, the important strategy to answer graphics items is to pay attention to detail. The differences between the answer options may be slight, so make sure you look at each option carefully before picking one.
Audio Questions: Audio items present candidates with an audio clip to listen to and then asks a question based on the content of that clip.
How to tackle it: Are you getting tired of hearing how important paying attention to detail is yet? Just like the others, audio questions require your full attention. Try listening to the clip two or three times to make sure you absorb all of the information before you take a stab at answering the question.
Where Should You Go From Here?
Reviewing all of the information about the NCLEX and its various components is an important part of your preparation, and beginning at the source is a great place to start! The NCSBN website has many resources to help familiarize you with the test, including What the Exam Looks Like and a detailed test plan for each version of the exam.
Related read: 12 NCSBN Resources You’ll Be Glad You Read before Taking the NCLEX
But of course, the most important thing that you can do to prepare yourself to tackle the alternate items on the NCLEX is to practice, practice, practice! The more you are exposed to the different types of alternate item formats, the more confident you will feel answering them during the real deal.
Wanting added practice? Get started with this helpful video from ATI’s own nurse educators – Prep Live! ATI’s Mini NCLEX Review.
