NCLEX-RN® Question Types

The NCLEX-RN® is composed of primarily multiple-choice, four-option, text-based questions written at the application/analysis level of difficulty. These questions may include charts, tables, or graphic images. There are three components of an NCLEX-RN® exam multiple-choice question. They are as follows:

  • The stem of the question. The stem includes the situation that describes the client, his or her problems or health care needs, and other relevant information. It also includes a question or an incomplete statement. This is the question that you must answer.
  • Three incorrect answers, referred to here as distracters.
  • The correct answer.

The three distracters will probably sound logical to you. They may even be based on information provided in the stem, but they don’t really answer the question. Other incorrect answers may be actions that are common nursing practice but not ideal nursing practice.
The correct answer is the only choice that is recognized as correct by the NCLEX-RN® exam, so you need to learn to select it. Remember that most answer choices are written at the application level: you will not be able to select answers based on recognition or recall. You must understand the whys of nursing care in order to select the correct response.
Here’s an NCLEX-RN® sample practice question:

NCLEX-RN® Sample Practice Question

A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparotomy is scheduled. Preoperatively, which of the following goals is MOST important for the nurse to include on the client’s plan of care?

1. Fluid replacement

2. Pain relief

3. Emotional support

4. Respiratory therapy

Answer choice (1), fluid replacement, makes sense because this client has a ruptured ectopic pregnancy. An ectopic pregnancy is implantation of the fertilized ovum in a site other than the endometrial lining, usually the fallopian tube. Initially, the pregnancy is normal; but as the embryo outgrows the fallopian tube, the tube ruptures, causing extensive bleeding into the abdominal cavity. Answer choice (4), respiratory therapy, does not make sense with a ruptured ectopic pregnancy. The obstetrical client is not likely to need respiratory care prior to surgery. After reading this question, many students select answer choices (2) or (3) as the correct answer. They justify this by emphasizing the importance of managing this woman’s pain, or addressing her grief about losing the pregnancy. However, Neither answer choice takes priority over the physiological demand of fluid replacement prior to surgery.

NCLEX-RN® Alternate Format Test Questions

Your NCLEX-RN® exam may also contain questions in a format other than traditional four-option, text-based, multiple-choice questions. These other types of questions, called alternate questions, are part of the test pool of questions for the NCLEX-RN® exam. These alternate format question types include:
  • Multiple response questions

    Multiple response questions require you to select all answer choices that apply from among five or six answer options

  • “Hot spot” questions

    “Hot spot” questions require you to identify a “hot spot” or specific area on a graphic image by clicking on the correct area with the mouse

  • Fill-in-the-blank questions

    Fill-in-the-blank questions require you to calculate a number and then type it into a blank space provided after the question

There are also three types of alternate format questions that are variations on the traditional four-option multiple-choice question. These include:
  • Chart/exhibit questions

    Chart/exhibit questions require you to click an Exhibit button to display charts and/or exhibits that provide information needed to answer the question. Once you have done so, you then select the correct choice from among four multiple-choice answer options.

  • Audio item questions

    Audio item questions present you with an audio clip that you listen to on headphones. After listening to the clip, you then select the correct choice from among four multiple-choice answer options.

  • Graphics questions

    Graphics questions present you with graphics instead of text as the four multiple-choice answer options.

These questions are either counted toward your NCLEX-RN® exam results or they are experimental questions for future exams that are not counted.
Next: Alternate Format Questions >