Select All That Apply: The Most Hated Question Type Ever

There are a lot of changes coming on the new NCLEX in 2023, but Select All That Apply (SATA) questions are here to stay. The good news? Partial Credit is also coming! But for now, most students really hate SATAs – I know I did. I always felt insecure and powerless when answering them. Read on for some tools to remove your anxiety and conquer the SATA! Students NCLEX Article

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Select All That Apply: The Most Hated Question Type Ever

Why are SATAs so hard?

  • Did you know that anxiety makes it hard for you to recall information? Imagine you are sitting down to take the NCLEX and the first question is a SATA. Maybe you missed a lot of SATAs in nursing school and have learned to fear them. The question is about beta blockers and you KNOW this – you know all there is to know about beta blockers, but you freeze – your anxiety has blocked your brain.
  • Students tend to find SATA questions intimidating and we often avoid what we don’t like. Many students don’t practice SATAs because they hate them so much.
  • You may have been taught to approach all SATA questions as True/False. This is only one strategy – and certainly not the ONLY strategy.
  • All NCLEX questions are about the textbook standard of care. Don’t get sidetracked by something you encountered in clinical.
  • Students often rush through a question without really understanding what the question is really asking.
  • Students will often choose an answer because it sounds good – but it is actually wrong. Make sure the answers you choose apply to the problem in the question.

TIPS

  1. Avoid anxiety by mastering content and have NCLEX test-taking strategies
  2. Figure out what the question is really asking. You need to identify the problem that requires resolution. Try asking, “What is the problem here?”
  3. Only choose answers that directly apply to the problem – choose answers that are immediately necessary, relevant and specific.
  4. Choose answers that reflect safe nursing care that applies to MOST people (avoid outliers)
  5. Run each answer through a T/F filter, while remembering that this is not the only strategy to use
  6. Ask yourself: Would the answer option help the patient, harm them or do nothing? This is super useful for intervention questions.
  7. Are two of the answers connected or very similar? If you pick one, then you have to pick the other.
  8. This rule applies for conflicting answers as well. Don’t choose two answers that are opposites.
  9. Use common sense
  10. PRACTICE

Practice Questions

For each question, try to answer it on your own first, then scroll down to see my discussion of the correct answers.

#1 Pharmacological Therapies

The nurse teaches a client about the use of clonidine hydrochloride transdermal patches. Which statement by the client indicates they have understood the teaching?

Select all that apply

A. “I remove my patch every morning before I take a shower and put a new one on in the evening.”

B. “I should alternate between putting the patch on my right arm and then my left arm.”

C. “I should move slowly when I stand up so I don’t fall.”

D. “If I have any side effects, I need to remove the patch right away.”

E. “This medication takes a few weeks to start working.”

F. “If I feel sleepy, even if it’s the middle of the day, I can take a nap.”

Strategy

Look for the items that are correct or “right” by asking yourself, “Is this something a client would say if they understood the directions?” Or even simpler, “Is this a true statement about clonidine hydrochloride transdermal patches?”

You must have a good understanding of nursing content. Review what you know about these patches. What are they used for? How are they applied? How long does it take for the drug to take effect? What are the side effects?

If you can’t recall anything about the medication, try reading the answer options for clues. The clues I see are 1. It’s a patch and 2. It may cause sleepiness and orthostatic hypotension – this might be enough info to help you recall that clonidine is an antihypertensive (a centrally acting alpha2-adrenergic agonist that can also cause drowsiness, fatigue, dizziness, orthostatic hypotension, urinary retention and dry mouth.)

A. “I remove my patch every morning before I take a shower and put a new one on in the evening.”

This statement is FALSE. The patches should stay in place for a week, even while showering.

B. “I should alternate between putting the patch on my right arm and then my left arm.”

CORRECT: This answer is TRUE. The site should be changed with each application.

C. “I should move slowly when I stand up so I don’t fall.”

CORRECT: This is always a good idea! TRUE, but did you catch yourself "second guessing?" Maybe you have this little voice in your head that whispers "if it's too easy, it can't be right" - IGNORE that voice.

D. “If I have any side effects, I need to remove the patch right away.”

FALSE – Clonidine needs to be stopped gradually over several days to avoid rebound hypertension

E. “This medication takes a few weeks to start working.”

FALSE

F. “If I feel sleepy, even if it’s the middle of the day, I can take a nap.”

CORRECT: TRUE – another one that is always a good idea!

#2 Reduction of Risk

A toddler has honey-colored crusts, fluid filled vesicles and redness around the mouth and arm pits/axillae. Which statement by the child’s parent indicates further teaching is needed?

Select all that apply

A. “I need to isolate my child for a week.”

B. “The irritation was caused by my child using his pacifier.”

C. “I will use an antibiotic cream to treat this infection.”

D. “I should wash my hands before and after application of the topical antibiotic.”

E. “I should keep a food diary to discover what is causing this.”

F. “He can go back to daycare after we have used the antibiotic cream for 24 hours.”

Strategy

You are looking for "something wrong". The real question that is being asked is, “What is incorrect about etiology and treatment for this disease?” Or even better, “What is incorrect information about impetigo.” If you can’t recall information about impetigo, now is the time to review! When doing practice questions, be sure to study the content you miss.

A. “I need to isolate my child for a week.”

CORRECT: This statement is FALSE – Treatment for impetigo involves using good handwashing techniques. Notice this answer is in conflict with answer F, so don’t choose both.”

B. “The irritation was caused by my child using his pacifier.”

CORRECT: FALSE – Impetigo is a bacterial infection caused by staph or strep. It is related to poor hygiene or exposure to infection. Remember - we are looking for "something wrong", so the correct answers are the wrong ones.

C. “I will use an antibiotic cream to treat this infection.”

TRUE – knowing impetigo is a bacterial infection helps with this choice. Don’t get distracted by knowing that antibiotics can also be oral – this isn’t actually a true false question – don’t get distracted by your strategy – stick to the main question: “What is incorrect information about impetigo.”

D. “I should wash my hands before and after application of the topical antibiotic.”

This is always a good idea as it reduces risk of spreading the infection - TRUE

E. “I should keep a food diary to discover what is causing this.”

CORRECT: FALSE  – The skin lesions do not suggest a food allergy.

F. “He can go back to daycare after we have used the antibiotic cream for 24 hours.”

The child is contagious for 24 hours after starting antibiotics so this is TRUE. This answer is in conflict with “A” so be sure not to choose both.

#3  Basic Care and Comfort

The nurse manager determines that which clients on the unit are at risk for developing a pathological fracture?

Select all that apply

A. A 38 yr-old male diagnosed with bone cancer a year ago.

B. A 45 yr-old male newly diagnosed with type 2 diabetes.

C. A 50 yr-old male taking corticosterone for 3 years.

D. A 58-yr-old female who has been working the nightshift for 10 years.

E. A 62-yr-old male who has played soccer for the last 5 years

F. A 72-yr-old female diagnosed with osteoporosis 4 years ago.

Strategy

This question is asking who is at risk for a pathologic fracture. Be sure you don’t overthink this question. I immediately start looking at age and gender, but I know that pathological fractures don’t have anything to do with age or gender, unless you link them to osteoporosis, which is more likely in older women…I am going down a rabbit hole and thinking about menopause now…and STOP! This question is about PATHOLOGIC FRACTURE!! Focus! (this is how I talk to myself…hope you are smiling a little).

A. A 38 yr-old male diagnosed with bone cancer a year ago.

CORRECT: This person is at risk (risk factor = bone cancer)

B. A 45 yr-old male newly diagnosed with Hypertension.

No risk – no relationship between this disease and pathologic fracture

C. A 50 yr-old male taking corticosterone for 3 years.

CORRECT: Long term cortisone therapy puts you at risk for weakened bones

D. A 58-yr-old female who has been working the nightshift for 10 years.

CORRECT: Low sunlight exposure leads to low levels of vitamin D and vitamin D helps your body absorb calcium. This one is a hard one!

E. A 62-yr-old male who has played soccer for the last 5 years

No risk – this person is actually lowering their risk by engaging in physical activity

F. A 72-yr-old female diagnosed with osteoporosis 4 years ago.

CORRECT: Spontaneous fractures can occur due to osteoporosis

To Sum Up

If you know you’ve “messed up” on a question, the best thing you can do is move on. Take a deep breath and remember that you can’t get them all right! Giving yourself space for grace will reduce your anxiety and allow you to access all that impressive nursing knowledge.

What type of questions do you want to practice?

References

NCSBON info about Next Generation NCLEX Project

Getting Ready for the Next Generation NCLEX® (NGN): Frequently Asked Questions

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About SafetyNurse1968, BSN, MSN, PhD

Patient Safety Columnist / Educator

Dr. Kristi Miller, aka Safety Nurse is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is also a mother of four who loves to write so much that she would probably starve if her phone didn’t remind her to take a break. Her work experiences as a hospital nurse make it easy to skip using the bathroom to get in just a few more minutes on the computer. She is obsessed with patient safety. Please read her blog, Safety Rules! on allnurses.com. You can also get free Continuing Education at www.safetyfirstnursing.com.

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Specializes in RN.

I have just passed NCLEX. 32/75 questions were SATA. However, the test did not appear very hard at all!

Whether that was a select all that apply or multiple choice question, what was helpful the most for me is to always ask this question: 

What would be the outcome if I chose this intervention/option, and will it help the patient in relation to the situation/condition/diagnosis that has been presented or implied in the question?

Side note:

Q#3 option D is off. 

Question - "D: A 58-yr-old female who has been a vegetarian for 10 years."

Answer - D: A 58-yr-old female who works night shift and sleeps most of the day.

CORRECT: Low sunlight exposure leads to low levels of vitamin D and vitamin D helps your body absorb calcium. This one is a hard one."

These questions are taken from UWorld Qbank that provides even more detailed explanation to each of the options! 

 

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Specializes in Education, Informatics, Patient Safety.

I appreciate your comments! Could you explain what you mean by “off”? I wrote the question myself, so I’m surprised it’s on UWorld. Can you explain what you mean in a different way? Thank you!

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Specializes in RN.

My apologies. The wording, especially in the Q#3 is just like in UWorld. I guess, the options are limited, and questions appear to look similar.

In Q#3, option D asks whether a 58 y/o vegetarian female is at risk for bone fractures. In the answer, it mentiones a 58 y/o female who works nights and sleeps during the day. One of the SATA UWorld questions had the very same concept questioned: long-term vegetarian, therefore, unless a person uses vit D supplementation, they may be at risk for osteoporosis and bone fractures. True. 

Nevertheless, in the answer, the 58 y/o female instead of being a vegetarian has become the one who works nights and sleeps most of the day. Would that be a risk factor? Possible, since they are also having limited sun exposure.

Two different questions with the same consept under the same letter D in Q#3. That's why I said that it was off.

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Specializes in Education, Informatics, Patient Safety.

Ah! I didn’t reword the answer explanation ! Thank you! I’ll make the edit. My proofreader is on vacation ? 

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Specializes in RN.

Oh, I could use another pair of eyes to check my work as well! Critiquing someone else's work is always much easier.

Thank you for the tips on how to approach SATA questions. Strategy development to understanding "NCLEX style questions" and sticking to a study schedule had undeniably boosted my success in preparation for NCLEX. 

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Most nursing schools require passing standardized tests before passing the classes and graduating. Their SATAs were much harder than the actually NCLEX which I found extremely easy but also extremely weird at the same time. It’s based Med on a knowledge tree, so if you pass a question, you’re advance to a harder question until you miss one and they drop the question level. My minimum question NCLEX was at least 2/3  to 3/4 SATA, but easier SATA than what I expected and I always knew when I don’t get one right because I would get the occasional other format question….took RN NCLEX in w 2016….weirdest easy test I have ever taken…out in about an hour. Took my NLEX PN in 2002-that was just multiple choice but also easy. Nothing like the exams that were standardized for school. IDK, I passed with flying colors in both programs so maybe I’m not  the best source. The biggest thing is knowing how to read the test question and then analyzing each answer the NCLEX way for the answer.  It’s nice that they are now giving partial credit for the SATAs-it always felt like 5-6 or so T/F questions and a simple word could change the answer. Those questions, I made sure Toto read twice so I didn’t miss anything. Stil got a mostly SATA test though!

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