How to Answer Different Question Types on the NCLEX®

Osmosis recently hosted nurse Elizabeth “Liz” Lucas for an insightful webinar explaining the different types of NCLEX questions and providing some strategies for conquering them. In addition to working as a nurse, Liz is the Senior Content Manager at Osmosis and head of the question writing team for us. If you’re curious about the NCLEX and what it holds in store for you, read on as we break down Nurse Liz’s expert guidance!

What is the NCLEX?

This is the exam that all graduates of nursing programs have to pass before they become a registered nurse. The acronym stands for National Council Licensure Examination. The NCLEX is a computerized adaptive test, which means the test is going to change as you proceed. The test recognizes if you're answering the questions correctly or incorrectly and adapts to your choices.

How long is the exam?

On the current NCLEX exam, the minimum length is 85 questions and the maximum length is 145. Of those potential questions, up to 15 of those will be pre-test items, meaning that they don't directly count towards your score in any way. Pre-test questions provide data for the National Council State Boards of Nursing for future examinations. The maximum amount of time a student can take on the test is five hours, including a break.

What does the NCLEX test on?

The NCLEX tests on client needs categories. These categories are Safe and Effective Care, Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. Even though each person's NCLEX will be different from the next person, every single test taker will be tested on those categories.

What is the Next Generation NCLEX?

The NCLEX will undergo some significant changes, and the Next Generation NCLEX, or NGN, will launch in April 2023. The test will still be adaptive and have the same number of questions, including pre-test items, and test time length will remain the same. The two biggest differences are the Clinical Judgment Measurement Model and some new question types. The Clinical Judgment Measurement Model is going to measure your ability (or inability) to answer certain types of questions. It will test how you make clinical decisions, how you progress from assessing a client to actually making a clinical decision that impacts your client.

What types of questions will the NCLEX have?

The NCLEX has nine different types of questions. We’ll get into more specifics below, but here are all the question types you’ll see:

• Multiple choice
• Multiple response
• Fill-in-the-blank
• Cloze
• Hotspot
• Enhanced hotspot
• Ordered response
• Drag and drop
• Matrix

That’s a lot to plan for! Are there any general tips that apply to any question type?

Absolutely! We have lots of great tips in general.

First, read each question from start to finish slowly and thoroughly. A great technique is to try to answer the question in your head before you even read those options. Think about the correct answer and compare that to your list of options to see if any match. If you do find one that matches the one that was in your head, that's a pretty good indicator that you found the correct answer.

Secondly, stay calm when you come across something that isn't fully familiar to you. Look at the question and ask yourself what information you have and what you remember. Use that information to form your thoughts and your clinical judgment around this question.

Also, look for bolded words in the question. These are oftentimes called qualifiers, words like most, best, and first that can help guide your decision making when you're answering the question.

Use a highlighter if you're permitted, or mentally highlight important words or phrases that you want to be sure you come back to.

Read every single answer option even if you come across an option that is tempting and seems correct. We know that oftentimes in nursing it's less of a matter of right and wrong and more a matter of what's best. So, you might find a good option, but then you could find an even better option, so read them all.

A really great technique is to eliminate any options that are just distinctly incorrect. Either cross that off with your pencil or eliminate that one in your head so you can forget about it.

Don't spend too long answering questions; about a minute to a minute and a half maximum per question is all you should need. If you’re taking more than that, you run the risk of reading into the question or second guessing yourself: two kinds of traps that nursing students can get into that often alter their results to the negative.

Avoid reading something into the question that isn’t there. A lot of nursing students add in things that don't actually exist in the question. Don’t make the question more complicated than it is—just answer what is being specifically asked.

Finally, don't change your answer. Research shows that if you change your answer you're more likely to change a correct answer to an incorrect answer than the other way around.

How do I handle multiple choice?

This is the question type that you are probably most familiar with. You know that only one answer option is correct, so apply all those good question techniques to this one. This is a really great one to practice coming up with the answer in your head first since there is only one correct answer.

How do I handle multiple select?

A good way to approach this question is to decide if each option is true or false. You might reword each answer selection in your head; for example, “Does 20 20 vision correlate with acute closed angle glaucoma? True or false?” Answer it then move down and do the same thing with your next option. Each of those options can be considered independently of each other and that can help you break down the question into more manageable pieces.

What’s your advice for fill-in-the-blank questions?

Fill-in-the-blank questions involve a calculation, oftentimes a dosage calculation. Be sure that you're reading the instructions very carefully because they will provide you with details you need, especially rounding rules. For the NCLEX, all rounding is going to be done at the very end of the equation, so don't do rounding in steps. Make sure you note the unit of measurement that the question is asking for. Finally, once you get your answer, ask yourself if it makes logical sense. For example, if the answer you come up with is to administer 20 tablets of a medication in one dose, that's likely not the correct answer since there's pretty rare circumstances when we would ever administer 20 tablets of a single dose of the medication. That is a good clue that you need to go back and double-check your calculation.

What is a cloze and how do I tackle it?

In a cloze, something has intentionally been omitted, and it's the test taker's responsibility to complete it. In this question, you might have to add words or phrases to a sentence or table.

Consider each of your options individually and collectively because sometimes how you answer the first part will dictate what the rest of the question is asking. Make your choices and then reread your sentence or look at your table as a whole to make sure it is accurate.

What advice do you have for hot spot questions?

In a hot spot, you're going to interact with the image on the screen. This is another question type where you should carefully read the directions because they might change from one question to the next. You might be presented with an electronic health record to click on and fill in information or perhaps a body where you’d be instructed to indicate the location of an apical pulse. If you happen to misclick you can change your answer. These questions are detail oriented, so focus on what is being asked. Always consider the position of a body—for example anterior or posterior, left or right side—because these details might alter your answer.

How about those ordered response questions?

In an ordered response question, you're going to place items in order using radio buttons. These questions ask you about the ways nurses prioritize; remember that ordering is simply another word for prioritizing. Once you’ve put everything in order, re-read all your options in the order you select it, and ask yourself if anything appears out of order. If it reads through logically from start to finish, you’re good to go!

Tell me about drag and drop questions.

Drag and drop items can vary from question to question and how they function. There’s not a hard and fast rule for these—just be sure to read the specific instructions for each question. Don’t assume that one drag and drop has the same instructions as a previous one.

Last but not least: How should I approach a matrix question?

A matrix item will ask you to categorize options, so you can approach these with a similar strategy to a multiple select question. Choose each solution that applies and remember to consider each option independently.

What resources should I use to study for the NCLEX?

That is a great question! The National Council State Boards of Nursing website provides an NCLEX test plan which is a great place to start. Plan out your study sessions leading up to the exam date. The test plan provides more information about the client needs categories and how you can prepare for the exam.

Also, take practice exams. The more practice you have with these different question types, the greater comfort you'll feel. Read the question directions, and practice picking out the bolded sections that help you know how to answer the question.

About the Author

Elizabeth Lucas, EdD, RN, CNE has been an RN since 2008 and has an Ed.D. with Emphasis in Nursing and Health Professions Education. Liz’s clinical background is in oncology, and she later transitioned into nursing academia where she taught in a pre-licensure nursing program for several years. Liz feels passionate about building a strong nursing workforce through increasing education accessibility and believes in the role of technology in that pursuit. At Osmosis, Liz manages the nursing assessment and scripting teams. Liz currently lives near Baltimore, MD with her husband, two sons, and dog.

Osmosis is here to help. From our NCLEX question of the day series to our engaging illustrated videos, we have tons of resources to help you study. We also have NCLEX and Next Gen NCLEX style practice questions created by nurses to help students. Use our quiz builder with the useful highlight function.