How to Break Down NCLEX Questions

1. Understanding the NCLEX Question Format

There’s no point in denying it — NCLEX questions can be confusing. Many test takers with great nursing knowledge and instincts slip up by misreading the exam. Avoid this pitfall by breaking down NCLEX questions to understand their format and phrasing. When you get to the core of what they’re asking, you can let your nursing knowledge shine.

Multiple Choice NCLEX Questions

The majority of NCLEX questions are multiple choice and formatted with a stem and several answers. The stem lays out the nursing scenario and asks a question. It can be a short sentence or more detailed, with up to a paragraph of information. The answers are the multiple choice options. When you’re reading a multiple choice NCLEX question, read through the stem and pay close attention to whether it is a positive, negative, or priority question.

A. Positive questions ask you to identify the one correct answer. Positive questions are the most straightforward and often include keywords like the following:

• appropriate
• true
• correct
• indicated

B. Negative questions ask you to identify a false answer. The wording on negative questions can be hard to catch because the test rarely says something as clear as “the following are true except…” Keep an eye out for words and phrases that indicate that a qualified nurse would step in, stop a student from performing certain actions, or would teach a student more. Some words to look out for in the question stem are:

• avoid
• contraindicated
• not/never
• least
• further education
• refute
• negate

C. Priority questions ask you to choose which answer from several correct options is the most important, most correct, or should occur first. Keywords that indicate a priority question include:

• most appropriate
• best
• first
• priority
• primary
• initial

Read more about how to answer NCLEX priority questions, and check out this blog post for more multiple choice tips and strategies.

Alternate Format NCLEX Questions

The NCLEX uses an adaptive learning model to administer the exam which means everyone gets a slightly different mix of NCLEX questions, but you can expect that you’ll encounter some that aren’t formatted as multiple choice. These are called alternate format NCLEX questions. Below are a few of the different types of alternate-format questions you can expect to encounter:

• Audio Questions — You’ll listen to an audio clip and answer a question about it. Be familiar with normal heart, lung, and bowel sounds to prepare for audio format NCLEX questions.
• Chart/Exhibit Questions — You’ll be presented with a medical chart or exhibit that provides context for anything from one multiple choice question to six alternate format questions. Pay attention to all the details and look for clues that will help you answer correctly.
• Graphic Questions — Graphic questions consist of a question with images as the answers. You’ll click an image instead of selecting from written options. For example, you may see four heart rhythm images and have to click on the image that would be shockable.
• Hot Spot Questions — These questions often show an image of a body part or a scan. You’ll click on an area of the image or scan that’s indicated in the question’s scenario. For example, you may be presented with an image of a lung scan and asked to identify the location of an abnormality by clicking on that part of the image.
• Multiple Response Questions (aka Select all that apply or SATA)— Unlike multiple choice questions where you only select the single best answer, on multiple response questions, you’ll be asked to select every answer that applies. One way you can assess this kind of question is to consider each option independently and evaluate each option as a true or false question.
• Ordered Response Questions — Ordered response questions require you to drag and drop answer options into the correct sequence. These can also be used to rank options by priority. For example, would you first give oxygen to a client who has shortness of breath or sit them up in bed.
• Fill In the Blank Questions — Fill in the blank questions are usually reserved for calculations, and don’t worry, you will have a calculator available to you during the NCLEX. You’ll type an answer directly into the answer box.
• Bowtie Questions — The Bowtie Question on the NCLEX-RN is a type of multiple-choice question that presents a clinical scenario and asks test takers to identify the most critical nursing intervention to prevent a potential adverse event while also considering the possible consequences of various choices.

The same close reading and critical thinking skills you’ll use for multiple choice apply to alternate format questions. Check out this blog post for more information on alternate format NCLEX questions.

2. Identify the Key Information

After you’re comfortable with the question format, the next step in breaking down NCLEX questions is to look for key information. Keep a sharp eye out for:

• Client data: age, weight, gender, etc.
• Symptoms
• Relevant clinical details: any diagnoses, if they are post-op, or other details
• Vital signs and lab results
• Medications and doses
• Numbers included in the question stem

Pay close attention to keywords that indicate what each NCLEX question is asking for. For example, a question may provide client details and a scenario, then ask you how you might educate the client on home care. The word “educate” is key here, and offers a huge clue to which answer is correct. If one of the options explains the correct medical treatment for the patient, it could distract you from the correct answer about appropriate patient education.

Expert tip! If the primary focus of the question is “ client education,” eliminate distraction answers by honing in on education-only responses.

3. Analyze the Client Scenario

You know the NCLEX question’s format and you’ve pulled all the data to help you answer it. Now, let’s get a handle on the overarching client scenario.

Say it Your Own Way

Rephrasing the question in your own words will help you get to the core of the question. You’ll prove to yourself that you have a good handle on what the question is asking, which may also give you crucial insights into the client’s condition that will help you answer the question correctly.

Take the Holistic Approach

When you break down NCLEX questions, remember that every detail is relevant. Don’t assume anything about the patient scenario that isn’t explicitly stated, but don’t throw out any information they do give you. If you ever ask “but what if…” you’ve changed the question. Look for these clues when establishing the patient’s scenario and context:

• Social and cultural background
• Age
• Health history
• Symptoms
• Emotional state
• Any other factor that contributes to their care

In Joyce’s nursing programs, students learn about holistic nursing practices a that knowledge can be applied here. Consider Maslow’s Hierarchy of Needs and look at the question with insight into a whole person with physiological and psychosocial needs. This is especially important when encountering questions about therapeutic communication, which you can read more about in this article.

4. Rule Out Incorrect Options

Multiple choice NCLEX questions will have one correct answer and three decoy answers. These strategies can help you rule out incorrect options and eliminate the distractors :

Repeats

If there are three answers with similar meaning and one is different, the different answer is likely correct.

Absolutes

Life, health, and nursing rarely deal with certainties. You can usually eliminate answers with absolute wording, including:

• Will
• Always
• Never
• All
• None
• Unrelated Answers

Beware of red herrings! Sometimes an option will bring in an approach or body system that is unrelated to the question stem, and is very likely incorrect. For example, if the question asks about laboratory work but the answer explains correct client education for the disease process, you have to remember what the question is actually asking. If an answer seems random, it probably is.

Shortcuts

The NCLEX is focused on textbook answers more than the sometimes messy realities of nursing life. Unless otherwise indicated, your answers should reflect thorough nursing practice under ideal conditions with ample time, staff, and resources.

The Process of Elimination

If you’re really stuck on an NCLEX question, the process of elimination can increase your odds of making a more educated guess. Rule out obviously false answers before you close your eyes and click at random.

5. Apply Critical Thinking Skills

On the NCLEX, you will need to use critical thinking and clinical judgment to understand situations, apply your knowledge, and make decisions that align with nursing best practices. Because this exam is designed to measure the way you apply knowledge in realistic nursing problems, memorization is not the most effective technique for passing this exam.

Break down NCLEX questions to help you analyze and prioritize information and arrive at the best possible answers. Here are some specific critical thinking skills that will help you pass the NCLEX.

Read NCLEX Questions Closely

Misreading the question is one of the most common NCLEX pitfalls. Pay attention to the question’s wording and be clear on its intent before you even look at the answers. Then, pay close attention to each of the answers and their phrasing. It can also help to read through each NCLEX question more than once.

Look for Patterns

Finding patterns in NCLEX questions and answers can help you build mental connections and answer correctly. Look out for patterns, like groups of possible answers that mean the same or similar things, answers that address physiological versus psychosocial needs, or answers about assessing a situation versus implementing action.

Finding connections between situations is another critical thinking skill that will serve you on the NCLEX and during your nursing career. Successful nurses apply the knowledge they gain from one situation to other relevant circumstances, both during the NCLEX and in clinical practice.

6. Prioritize Safety and Basic Cares

There is another tool that can help you prioritize safety. When in doubt about how to help a client, remember to check their Airway, Breathing, and Circulation. Prioritizing safety and basic cares is another strategy to break down NCLEX questions. Client safety comes first. Here are some things to consider when choosing the safest course of action:

• Meet the client’s most basic physiological needs: oxygen, food, elimination, and fluids
• Prevent injury, including worsening physical condition
• Decrease the risk of disease

Keep an eye out for potential risks and complications that may arise from a client’s condition. The answer that best addresses risk and improves outcomes is likely correct.

Remember your Nursing ABCs.

7. Select the Best Answer

You’ve taken the time to read, reread, and break down an NCLEX question. You understand its format, have identified key information, and analyzed the client scenario. You ruled out decoy answers, then used critical thinking and prioritized safety to come up with the best options. At some point you have to click on an answer.

Because the NCLEX is formatted to make you think, lots of candidates find themselves overthinking. It’s important that you make a decision, then don’t look back. Most of the time when you change your answer, you move from a correct to an incorrect answer.

Choose your answer, take a deep breath, and move onto the next question.

Read more about how to avoid overthinking the NCLEX.

8. Review Answer Rationales on Practice Tests

The point of NCLEX practice tests isn’t to prove to yourself that you already know how to pass the exam. The point of practice tests is to learn how to take the NCLEX. Wrong answers on NCLEX practice questions can teach you just as much as correct ones if you review the answer rationales.

Because this exam is different from pretty much every other test you’ve taken, you need to learn to think like the NCLEX. Studying answer rationales on NCLEX practice questions will help you understand why the correct answer is right and why the incorrect options are wrong. This is one of the best ways to get NCLEX logic deep in your brain. Then, when it comes to test day, you won’t be blindsided by question formats or thinking exercises.

9. Practice, Practice, Practice

Nursing knowledge, great notes, and strategy only go so far. To pass the NCLEX, you’ll have to consistently practice breaking down NCLEX questions. Here are some NCLEX preparation tips:

• Make yourself a study schedule that includes both full NCLEX practice tests and short study sessions. This gets your brain used to sitting down and focusing on the NCLEX for an extended time, but also makes casual practice part of your routine.
• Get familiar with NCLEX practice questions and their phrasing. This blog has examples of the different kinds of questions you can expect to answer on exam day.
• Find and use high quality study materials. You can find four of our favorite NCLEX study guides on this blog.
• Take note of your strengths and weaknesses so you can target your practice. The NCLEX Mastery RN app can help you track this.

You can find more NCLEX study tips in this blog post.

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