NCLEX-RN Alternate Format Questions: Hot Spot

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NCLEX-RN® Hot Spot questions ask you to identify a location on a graphic or table. It is important to understand that this is not a test of your fine motor skills but is designed to evaluate your knowledge of nursing content, anatomy, and physiology and pathophysiology Like select all that apply, fill-in-the-blank, and drag-and-drop questions, these types of questions are called alternate format questions and are part of the test pool of questions for the NCLEX-RN exam.
 
Let’s take a look at an example:

NCLEX-RN Alternate Format Practice Question


The nurse performs a physical assessment on an adult male. Identify the area where the nurse should place the stethoscope to auscultate heart sounds heard in the tricuspid area.
NCLEX Alternate Format Hot Spot Practice Question


Strategies for Alternate Format Questions: Hot Spot


This question asks you to identify where you would listen to heart sounds in the tricuspid area. The strategy you should use is to locate anatomical landmarks. You need to know that the tricuspid area is located on the client’s left side. It is found in the space between ribs, two ribs up from the bottom of the seven true ribs. The tricuspid area is located in the fourth and fifth intercostal spaces at the lower left of the sternal border.
Using the computer’s mouse, move the cursor to the location you think is correct. Then, left-click the mouse. Check to make sure that you have selected the location you wanted. Then enter your answer by clicking on the NEXT (N) button or pressing the Enter key. If you click on the right side of the chest, or four ribs up from the bottom, or at the midclavicular area instead of the sternal border, the location would be inaccurate for the tricuspid area and the question would be counted as incorrect. Just do your best and use anatomical landmarks to get your bearings and select the location.

Solving Alternate Format Questions: Hot Spot


Here’s the answer to this hot spot alternate format question.

The nurse performs a physical assessment on an adult male. Identify the area where the nurse should place the stethoscope to auscultate heart sounds heard in the tricuspid area.
NCLEX RN FORMAT ALTERNATE HOT SPOT PRACTICE


It is important for you to know where to listen to specific heart sounds. In addition to the tricuspid area, you should be able to locate other anatomical landmarks to evaluate heart sounds:

  • Angle of Louis

    The manubrial sternal junction at the second rib

  • Aortic area

    The second intercostal space to the right of the sternum

  • Pulmonic area

    The second intercostal space to the left of the sternum

  • Erb’s point

    The third intercostal space to the left of the sternum

  • Mitral area

    The fifth intercostal space at the left midclavicular line


In the mitral area of an adult is the apical impulse, also known the point of maximal impulse (PMI), where the impulse of the left ventricle is felt most strongly; on an infant, the apical impulse is lateral to the left nipple.
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