How to Ace Alternate-Style Questions on the NCLEX-RN

Now that you’ve done all the hard work at nursing school, it’s time to prove you’re really ready to become a nurse. To do that, you’ll have to take the National Council Licensure Examination (NCLEX). Are you ready?
You’ll take the NCLEX-RN on a computer at a Pearson VUE test center, answering questions that show you can apply your knowledge of nursing practice to the duties of a registered nurse.
For the most part, you’ll be choosing one correct answer from among four multiple-choice options for each question. But not always. You’ll also need to be prepared for “alternate item format questions.”
Examples of alternate-style items include questions with two or more correct answers (“select all that apply”), questions that require putting the answer options in order, and questions that require you to identify a specific area on a picture or graphic. You might also have to read info in a chart to answer the problem, listen to an audio clip, or choose among several graphics instead of written answer options.
The National Council of State Boards of Nursing (NCSBN) offers all kinds of useful information about alternate item format questions.
 

These alternate-style questions are fairly new in NCLEX history. Advances in computer technology have allowed the test developers more options than the simpler four-answer multiple-choice format.
Alternate-style questions offer a more effective way to assess entry-level nursing competence. For example, calculation questions require you to do the math and fill in the blank with no answer options to choose from, just like real life.
In the professional licensing world, alternate-style questions are not at all unusual. If you were to take a licensure exam to become a doctor, architect, or accountant, you’d also encounter non-multiple-choice questions being use to determine competence.

According to the NCSBN, there is no set number or percentage of alternate-style questions on any given NCLEX-RN. But you can expect between 10 to 20 percent alternate-style questions.
The test is computer adaptive. That is, the computer takes into account your answers and adjusts the questions in difficulty accordingly. No matter what difficulty level, you will encounter alternate-style questions.
Alternate-style questions are scored the same way as multiple-choice questions: right or wrong. There is no partial credit for calculations or getting some of the “select all that apply” answers correct.


Many students find alternate-style questions more challenging than the regular multiple-choice format. The best way to prepare for these questions is to practice them in advance.
Here are some ways to find practice questions:

• Visit the NCSBN website and take their tutorial to access and view alternative item formats.
• Google “alternate item format questions.” There are many free practice questions available online.
• Consider investing in an NCLEX-RN review course.

From a strategy standpoint, here are two other tips: 

• Make sure you follow the directions exactly. Example: For calculator questions, be sure to use the correct decimal place in the answer when asked. If you answer with a whole number, it will be wrong.
• Spend time to understand what the question is asking. What about the topic does the test want you to prove you understand? With that goal in mind, you can compare the options.