What I was taught was that alternate format questions are the higher level questions. If you receive an alternate format question, you are doing good. Imagine there is an invisible line going across your screen, they want you to stay above that line, so you have to start off strong and stay above the line. If you start to miss questions you go down below the line(bad news), questions get easier and the test tries to get you back up to the line and above.
I started of with 6 multiple choice questions. Then I got about 6 alternate format questions in a row. I knew I was doing good, so I relaxed a little. In total I had about 20 alternate format questions and only got 75 questions before the test shut off.
Remember, if you get 75 or 265 question 15 are "test" questions that do not count. Along with that if you get a few wrong, its OK. I took a review course with the woman who wrote many of the Saunders NCLEX review books, read the 50 shades of gray trilogy, studied out of the Saunders yellow book and passed with flying colors. But the test was the hardest test of my life. Best of luck