Alternate Format Test Questions

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Let’s take a look at the individual alternate format question types and the strategies that help you correctly answer these questions.

Select All That Apply—Click on all appropriate answer choices

Take a look at the following question:

1. The LPN/LVN is caring for a client diagnosed with a right-sided stroke with dysphagia. Which of the following actions by the LPN/LVN reflects appropriate care for the client? Select all that apply.
   1. ☐ The LPN/LVN assesses the client’s ability to swallow.
   2. ☐The LPN/LVN positions the client with the head of bed elevated 25 degrees.
   3. ☐The LPN/LVN offers the client scrambled eggs.
   4. ☐The LPN/LVN instructs the client to place food on the left side of the mouth.
   5. ☐The LPN/LVN turns off the television.

You will know that the question is a “Select all that apply” alternate format question because after the question stem and before the answer choices you are instructed to “Select all that apply.” You will note that there are more than four possible answer choices; usually five or six are provided. Also, there is a box in front of each answer choice rather than the radio button you see with multiple-choice, four-option, text-based questions.

To answer this type of question, determine which of the answer choices provided are correct. It is important to remember that in order for the question to be scored as correct you must select all of the correct responses that apply, not just the best response. You will not receive any partial credit if you do not. Left-click on the box in front of each answer choice that you think is correct. A small check mark appears in the box indicating that you selected that answer. If you change your mind about a particular answer choice, just click on the box again: the check mark disappears and the answer choice is no longer selected.

How should you approach this type of question? What doesn’t work is to compare and contrast the individual answer choices. For a “Select all that apply” question, any number of answer choices may be correct. Instead, consider each answer choice a True/False question. Reword this question to ask, “What is appropriate care for a client with a right-sided stroke who has dysphagia?” Dysphagia means the client is having difficulty swallowing; if the stroke is in the right hemisphere, the client’s left side is affected.

Let’s look at the answers. The strategy is to change each answer choice into a statement, and then determine whether the statement is true or false.

1. “I should assess the client’s ability to swallow.” Is this true for a client with dysphagia? Yes. This is a correct response because the nurse needs to make sure that the client can swallow food before giving him anything to eat. The results of the evaluation will also determine whether the nurse should offer the client clear liquids or thickened liquids. Some clients will require thickened liquids while others will not. Select this answer choice.
2. “I should position the client with the head of bed elevated 25 degrees.” Is this the correct position for a client with dysphagia? No. The client should be sitting upright in a chair or with the head of the bed elevated to at least 30 degrees. Eliminate this answer choice.
3. “I should offer the client scrambled eggs.” Is this an appropriate food for a client with dysphagia? Yes. Soft or semi-soft foods are more easily tolerated than a regular diet. Select this answer choice.
4. “I should instruct the client to place food on the left side of the mouth.” Is this what should be done? If the client has a right-sided stroke, that means the left side of the client’s body is affected. The food should be placed on the unaffected side—the right side of the mouth for this client. Eliminate this answer.
5. “I should turn off the television.” What are they getting at with this statement? Many clients are easily distracted after a stroke. If the client has dysphagia, you don’t want him to aspirate while being distracted by the television. It is best to turn off the TV during meals. Select this answer choice.

So, which answers should be checked as correct? For this question, choices (1), (3), and (5) are correct. Left-click on the box in front of each of these answer choices to select them. When you have selected all the responses you believe to be correct, click on the NEXT (N) button in the bottom left of the screen or press the Enter key on the keyboard to lock in your answer and go on to the next question. Remember, once you click on the NEXT (N) button or press the Enter key, you have entered your answer to the question and you cannot return to the question.

1. The LPN/LVN is caring for a client diagnosed with a right-sided stroke with dysphagia. Which of the following actions by the LPN/LVN reflects appropriate care for the client? Select all that apply.
   1. ☑ The LPN/LVN assesses the client’s ability to swallow.
   2. ☐ The LPN/LVN positions the client with the head of bed elevated 25 degrees.
   3. ☑ The LPN/LVN offers the client scrambled eggs.
   4. ☐ The LPN/LVN instructs the client to place food on the left side of the mouth.
   5. ☑ The LPN/LVN turns off the client's television.

Hot Spot—Select the correct area and click the mouse

This type of alternate format question asks you to identify a location on a graphic or table. It is important to understand that this is not a test of your fine motor skills but is designed to evaluate your knowledge of nursing content, anatomy, physiology, and pathophysiology.

Let’s take a look at a question that involves a hot spot.

The LPN/LVN is palpating peripheral pulses on an adult client. Identify the appropriate area in which the LPN/LVN would expect to palpate a client’s dorsalis pedis pulse.

The question asks you to identify where you would palpate one of the two commonly assessed peripheral pulses found in the foot. The strategy you should use is to locate anatomical landmarks. You need to know that the dorsalis pedis pulse is located on the top (dorsum) of the client’s foot. It is found between the first and second metatarsal bones (between the great and first toes) over the dorsalis pedis artery.

Using the computer’s mouse, move the cursor to the location you think is correct. Then, left-click the mouse. Check to make sure that you have selected the location you wanted. Then enter your answer by clicking on the NEXT (N) button or pressing the Enter key. If you click between the second and third toes, for example, the location would be inaccurate for the dorsalis pedis pulse and the question would be counted wrong. Just do your best and use the anatomical landmarks to get your bearings and select the location.

The LPN/LVN is palpating peripheral pulses on an adult client. Identify the appropriate area in which the LPN/LVN would expect to palpate a client’s dorsalis pedis pulse.

Fill in the Blank—Enter the answer

This type of alternate format question asks you to fill in the blank with a number based on a calculation.

The following is a sample of a fill-in-the-blank question that is a calculation.

The LPN/LVN is caring for a client who has a primary health care provider order for strict intake and output. The client drinks 12 oz  of lemon-lime soda and 1/2 cup grape juice between breakfast and lunch, and voids 200 mL of urine. Calculate and record the client’s oral intake in milliliters for this period.

 mL

To answer this question, calculate the client’s intake from the information provided. Note: Pay close attention to the unit of measure you need for your final answer. In this situation, you are asked for the client’s intake in milliliters, not cups or ounces.

You can use the drop-down calculator provided on the computer to do the math. The button that displays the calculator is on the bottom of the right side of the computer screen. Use your mouse to click on the numbers or functions you want. Remember, the slash (/) is used for division.

First, convert cups into ounces. One cup of fluid = 8 oz. Then convert ounces into milliliters. One ounce = 30 mL. The client’s intake is:

12 oz lemon-lime soda = 360 mL

1/2 cup grape juice = 4 oz = 120 mL

Use the computer mouse to move the cursor inside the text box. Left-click on the cursor. Type in the correct intake using the number keys on the keyboard. The correct answer is 480. Do not put “mL” or any unit of measure after the number. Only the number goes into the box. Rules for rounding are typically provided with the question.

The LPN/LVN is caring for a client who has a primary health care provider order for strict intake and output. The client drinks 12 oz of lemon-lime soda and 1/2 cup grape juice between breakfast and lunch, and voids 200 mL of urine. Calculate and record the client’s oral intake in milliliters for this period.

480mL

Drag and Drop/Ordered Response—Arrange the Answers in the Correct Order

This is one of the newer alternate format question types introduced by the NCSBN. These questions ask you to place answers in a specific order.

Take a look at the following question.

The nurse is preparing to insert an indwelling urinary catheter in a female client. Arrange the following steps in the order the LPN/LVN should perform them. All options must be used.

The strategy to use in answering this kind of question is to picture yourself performing the procedure. First, prepare the client. Next, prepare the equipment in the correct order, using sterile technique. Open the sterile insertion kit. Then, put on the sterile gloves.Next, inflate the balloon of the catheter to check for leaks. (NOTE: This step may vary per facility policy and manufacturer guidelines. Silicone catheter balloons should not be pre-inflated.). Lubricate the tip of the catheter. After preparing the equipment, prepare the client for the insertion of the catheter. The last step from those provided is to cleanse the periurethral area using swabsticks or cotton balls saturated with cleansing solution.

To place the options in the correct order, click on an option and drag it to the box on the right. You can also move an answer from the left column to the right column by highlighting the option and clicking the arrow key that points to the column on the right. You may also rearrange the order of the options in the right column using the arrow keys pointing up and down.

Here’s the answer to this question.

The nurse  is preparing to insert an indwelling urinary catheter in a female client. Arrange the following steps in the order the LPN/LVN should perform them. All options must be used.