Tackling NCLEX Alternate Format Practice Questions and Tips

Staff Writer
May 3, 2022

While last week’s NCLEX study tips offered strategies for multiple choice questions , this week, we are focusing on alternate format NCLEX practice questions and our best tips for answering them correctly. Remember that when you study for the NCLEX, it’s all about questions—not just what they ask, but how they ask. That’s where our helpful tips and practice questions come in.

What are NCLEX Alternate Format Questions?

Alternate format questions commonly appear on the NCLEX exam and include 7 different types:

  • Select All That Apply (also called Multiple Response)
  • Ordered Response
  • Fill-in-the-blank
  • Hot Spot
  • Exhibits/Chart
  • Graphic Options
  • Audio

For more on what each of these question types are, as well as NCLEX study tips and practice questions for each category, keep reading!

1. Select-All (or Multiple Response): Think “true or false.”

The select-all type questions are pretty self-explanatory: They include more than one answer in the same question, usually with five possible options. When you read through them, it’s best to consider each answer as either true and false, with the true options being the correct answers. Here’s the tricky thing: With these types of questions, you get all or no points. No partial credit is given if you choose only some of the correct answers. That may seem daunting and even frustrating, so remember to take your time. Make sure to review several select-all questions as you study so you’re familiar with and prepared for the format. Many students find these to be the most difficult questions, which means it can get easier from here.

Alternate Format NCLEX Practice Question:

The nurse is planning care for the patient returning from surgery for a colon resection and ileal pouch-anal anastomosis. Which interventions does the nurse employ to prevent surgical site infection? Select all that apply.

A. Perform diligent hand hygiene
B. Hold the patient’s scheduled heparin injections
C. Administer antibiotics within one hour of returning from surgery
D. Ensure sequential devices are in place and functional
E. Encourage the patient to use the incentive spirometer every hour while awake

Answer: A and C.

2. Ordered Response: Order everything.

Ordered response questions are those that require you to place the answer options in the correct order using the drag and drop method with the computer mouse. There’s nothing wrong here, but there is only one right order from start to finish. Whatever the scenario of the question, you’ll use all of the options and rank them in the correct order as directed.

Alternate Format NCLEX Practice Question:

The nurse prepares to place a nasogastric tube (NG tube) in an elderly male patient with a bowel obstruction. Arrange the following steps in the order the nurse should perform them. All options must be used.

A. Position patient in high-Fowler’s position.
B. Lubricate the tip of the tube with water-soluble lubricating jelly.
C. Instruct the patient to swallow as the tube is advanced.
D. Measure the length of the tube from the tip of the nose to the earlobe to the xiphoid process.
E. Anchor the tube with tape.
F. Insert the tube through the naris. Apply gentle downward pressure.

Answer: The correct order is A, D, B, F, C, E.

3. Fill-in-the-Blank: Study up on your calculations.

Fill-in-the-blank formats may seem intimidating, because you won’t have any answer in front of you, but with the right studying you’ll know exactly how to find it. These questions are often used for calculations of medication dosage, IV drip rates, intake and output, and due dates for pregnant women (using the first day of their last menstrual period as a guide). As long as you study and know how to do these and similar calculations, you’ll be fine.

Alternate Format NCLEX Practice Question:

The 25-week-gestation neonate is ordered to receive ampicillin 100 mg/kg/day intravenously, divided into doses every 12 hours immediately after birth. The neonate weighs 745 grams. The pharmacy dispenses ampicillin in a 5 mL vial that contains 125 mg. How many milliliters will the nurse administer with each dose? Round your answer to the nearest tenth decimal.

Answer: 1.5 mL.

4. Hot Spots: Pay attention to specific areas.

Hot spot questions are often used with pictures of a body part. You’ll be asked to use the mouse to click on the specific area indicated in the question’s scenario. For instance, you may be asked the best place to auscultate the apical heart rate. You would then click on the correct place on the picture of the chest.

Alternate Format NCLEX Practice Question:

The abdominal x-ray below belongs to a premature neonate with a distended and firm abdomen as well as bilious emesis. Which marker indicates the patient has experienced intestinal perforation? Select the appropriate area.

Answer: A.

5. Exhibits/Chart: Remember how to interpret (and use) bedside charts.

Exhibits/Chart questions include tabs that, when clicked on with the mouse, will give you more information about the client, similar to a bedside chart. There may be several tabs to open to reveal the information needed to answer the question. You’ll use this information to guide you toward the correct answer.

Alternate Format NCLEX Practice Question:

Client Chart

Medical History

  • Hypertension
  • Diabetes Mellitus Type 2
  • Hypothyroidism

Home Medications

  • Metoprolol 25 mg Daily
  • Metformin 500 mg BID
  • Levothyroxine 88 mcg Daily
  • Aspirin 81 mg Daily


  • Glucose 106 mg/dL
  • TSH 7.2 mIU/L
  • Free T4 0.2 ng/dL
  • Hemoglobin 10.7 mg/dL
  • Hematocrit 33%

The patient presents to the doctor’s office complaining of fatigue, hair loss, and cold sensitivity. The nurse anticipates that the physician will make a change to which of the patient’s home medications?

A. Metoprolol
B. Metformin
C. Levothyroxine
D. Aspirin

Answer: C.

6. Graphic: Think in pictures, not words.

Graphic questions use graphics (e.g., pictures, diagrams, heart rhythm tracings) instead of words as answer options. For instance, you may be asked to identify the heart rhythm that requires the most rapid action by the nurse, and would then choose from four different illustrations of rhythms. Or, you may be told that your laboring client is having back pain, so you would need to choose a picture of the best position to relieve this client’s pain.

Alternate Format NCLEX Practice Question:

Which anteroposterior chest radiograph is most consistent with the diagnosis of aspiration pneumonia?


Answer: B.

7. Audio: Listen close for answer clues.

Audio questions will require the use of headphones to listen to an audio clip of information. This may include heart sounds, lung sounds, or client speech patterns. You’ll then be asked to interpret what you hear or make a decision for care based on what you hear. Take your time, and listen closely. You’re allowed to replay the audio if needed.

Alternate Format NCLEX Practice Question:

During a shift assessment, the nurse auscultates the patient’s breath sounds. The nurse uses which term to document the findings? Attach your headphones and click on the audio file to listen.

A. Crackles
B. Inspiratory wheezing
C. Expiratory wheezing
D. Stridor


While taking the NCLEX exam can feel intimidating, you’ll greatly improve your odds of passing if you focus your study efforts on the types of questions you may be asked and strategies for ensuring that you answer them correctly. We hope our list of alternate format NCLEX practice questions and tips for answering each of the 7 question categories will get you well on your way. For more tips, check our posts on two other common NCLEX questions types: delegation and priority questions.

For even more NCLEX study strategies and advice, you can download our free NCLEX ebook .

Happy studying, and see you with more NCLEX study tips next week!

– Cheryl Armstrong, MS, RN
– Britt Baer, RN, MSN-HCSM, SANE

P.S. We love feedback. Post to our Facebook page with comments or requests for specific information you’d like to see in the series.

About NCLEX Wednesday: Joyce’s NCLEX review course has helped our nursing students pass the NCLEX with flying colors. We’re spreading the love to all nursing students as part of a weekly series. Nurses unite!


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