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☑️ NCLEX guideUpdated October 20267 min read4 practice questions

NCLEX select-all-that-apply (SATA) strategy for 2026

Select-all-that-apply used to be all-or-nothing, which is where most of the folklore about it comes from. Since April 2023 it has been scored for partial credit, and the right strategy follows directly from the scoring rule. Here is the rule, the method, and four SATA items to test it on.

How SATA is scored on the Next Gen NCLEX

NCSBN calls SATA an "extended multiple response" item, and it uses plus/minus scoring: in NCSBN's words, candidates "earn points by selecting the correct options, and points are deducted when they select the incorrect options". The maximum is the number of correct options; the item's total cannot go below zero.

Worked example with six options where three are correct:

You selectPoints
All three correct, nothing else3 of 3
Two correct, nothing else2 of 3
Three correct plus one wrong2 of 3
One correct plus two wrong0 of 3 (floored at zero)

Two things follow. A missed correct option costs you one point; a wrong extra option also costs you one point. So guessing an option you cannot justify is not free, and leaving out one you are unsure about costs exactly the same. Decide each option on its merits.

A related format, "select N" (the stem says "select the three findings that..."), is scored zero/one: you earn a point per correct pick and lose nothing for a wrong one, but you only get N picks, so the strategy is the same: rank, then choose the N you can defend.

The true/false method

Read the stem and decide what kind of thing it wants: expected findings, interventions, teaching points, risk factors. Then cover the other options and read each one as its own statement. Ask: is this true for this client, right now, as asked? Mark it yes or no. Do not count your yeses, do not compare options to each other, and do not look for a pattern.

Common stem words that flip the question: "requires follow-up" wants the abnormal or dangerous findings; "indicates understanding" wants correct statements; "needs further teaching" wants the wrong ones. The Question Is Hiding in the Last Sentence covers the keywords.

Myths to drop

  • "At least two are always right." NCSBN publishes no such rule. Judge each option.
  • "Never pick all of them." If every option is true, every option is right. Under plus/minus scoring the item pays for all of them.
  • "SATA is all or nothing." It was, before April 2023. Partial credit is now the rule for every multi-point item.
  • "Absolutes are always wrong." A heuristic for distractors, not a law: fixed safety rules are stated in absolutes ("never recap a used needle"). Distractors Have Tells lists the distractor tells and their exceptions.

A worked SATA, option by option

A client began a unit of packed red blood cells 10 minutes ago. Which findings require the nurse to stop the transfusion? Select all that apply.

  1. Temperature 38.6 °C (101.5 °F), up from 37.0 °C at baseline. A rise of 1 °C or more during a transfusion is a reaction until proven otherwise. True.
  2. Reports itching and has hives on the chest. An allergic reaction; stop the blood, keep the line open with normal saline. True.
  3. Says the room feels cold and asks for a blanket. Expected with a cold product running; not a reaction on its own. False.
  4. Low back pain and a heart rate of 118, up from 82. Classic early hemolytic signs. True.
  5. Blood pressure 128/78 from a baseline of 124/80. Within normal variation. False.
  6. States, "I'm nervous about getting someone else's blood." Anxiety, addressed with reassurance, not by stopping the transfusion. False.

Three true, three false, and at no point did the count matter. If you had ticked option 3 "to be safe", you would have scored 2 of 3 instead of 3 of 3. That is the whole strategy in one item.

What SATA tests, by category

SATA shows up everywhere, but the stems cluster: findings that need follow-up (Reduction of Risk, Physiological Adaptation), isolation and PPE lists (Safety and Infection Prevention and Control), medication teaching and adverse effects (Pharmacological Therapies), and client-rights and delegation lists (Management of Care). Matrix multiple-response items use the same plus/minus rule per column, so the method transfers.

The cure for SATA anxiety is volume with rationales: 20 SATA items a week, read every rationale, and note which option types you keep getting wrong (usually the "sounds bad but is expected" ones, like crackles in heart failure).

✅ Test yourself: 4 questions

Four select-all-that-apply items. Tap every option you can defend, then Check answer. Your score uses the exam's plus/minus rule. Every client is fictional; exam practice only, not medical advice.

Question 1 of 4 · Select all that apply

A client is admitted to the cardiac surgery unit after coronary artery bypass grafting with temporary epicardial pacing wires that are not connected to a pulse generator. Which actions by the nurse help protect the client from microshock? Select all that apply.

  1. Places the exposed wire ends in an insulating cover and secures them to the chest
  2. Tapes the bare wire ends to the metal bed frame so they cannot be pulled out
  3. Checks that all bedside equipment has intact, three-prong grounded plugs
  4. Wears gloves when handling the pacing wires
  5. Plugs the client's own electric shaver into an extension cord at the bedside
  6. Leaves the wire ends uncovered so they can be inspected at each assessment
Show the answer and rationale

Answer: A, C, D

Epicardial wires give electrical current a direct path to the heart, where a leakage current far too small to feel can trigger ventricular fibrillation. The nurse wears gloves to handle the wires, keeps the exposed ends insulated in a cover such as a glove or plastic sheath secured to the chest, and uses only intact, grounded equipment. Leaving the ends uncovered for inspection seems harmless but exposes them to stray current, taping them to a metal frame connects them to a conductor, and an unchecked personal device on an extension cord adds a possible source of leakage current.

📚 Learn it: RACE, PASS and the Hazards Hiding in Plain Sight

Question 2 of 4 · Select all that apply

A nurse makes a home visit to the parents of a 15-month-old who has just started walking and climbing. Which statements by the parents require follow-up? Select all that apply.

  1. 'Grandpa's handgun stays unloaded in a locked box, with the ammunition locked up separately.'
  2. 'Our medicines and cleaners are locked up, in their original containers.'
  3. 'We keep syrup of ipecac in the cabinet in case she swallows something.'
  4. 'The window screens are strong enough to keep her from falling out.'
  5. 'We turned the water heater down to 120 °F (49 °C).'
  6. 'We put a pressure-mounted gate at the top of the stairs.'
Show the answer and rationale

Answer: C, D, F

A pressure-mounted gate can be pushed loose and fall down the stairs with the child, so gates at the top of stairs are screwed into the wall, and window screens keep insects out but do not hold a child's weight; window guards or stops are used instead, with furniture kept away from windows. Syrup of ipecac is no longer recommended for home use because vomiting does not improve outcomes and can cause harm; the family calls Poison Control (1-800-222-1222) for any possible ingestion. Medicines and cleaners locked away in their original containers, a water heater set no higher than 120 °F (49 °C) and a firearm stored unloaded and locked, with the ammunition locked separately, are safe practices.

📚 Learn it: Falls: Bed Low, Wheels Locked, Call Light in Reach

Question 3 of 4 · Select all that apply

A nurse is teaching the adult son of a 72-year-old client who will take an oral chemotherapy tablet at home. Which instructions should the nurse include? Select all that apply.

  1. Wear disposable gloves when you handle the tablets.
  2. Crush the tablet into applesauce on days when your father has trouble swallowing.
  3. Count out the tablets on the kitchen counter where meals are prepared.
  4. Keep the tablets in their original container, away from food and out of children's reach.
  5. Your sister, who is pregnant, can give the doses on the days you work.
  6. Wash your hands with soap and water after each dose, even when you wore gloves.
Show the answer and rationale

Answer: A, D, F

Oral chemotherapy drugs are hazardous, so caregivers wear disposable gloves to handle them, wash their hands with soap and water afterward and keep the tablets in the original labeled container, away from food and drink and out of children's reach. Crushing is tempting when swallowing is hard, but it releases drug dust that can be inhaled or land on surfaces, so the nurse asks the oncology team about other options instead. Pregnant family members should not handle these drugs because of the risk to the fetus, and tablets are never counted out where food is prepared.

📚 Learn it: RACE, PASS and the Hazards Hiding in Plain Sight

Question 4 of 4 · Select all that apply

A nurse admits a 79-year-old client with community-acquired pneumonia to a medical unit. Which findings increase the client's risk of falling? Select all that apply.

  1. Takes a daily calcium and vitamin D supplement
  2. Takes diphenhydramine 25 mg at bedtime for sleep
  3. Serum sodium 128 mEq/L (128 mmol/L)
  4. Gets up two or three times each night to urinate, often urgently
  5. Blood pressure 134/78 mm Hg lying and 110/70 mm Hg after 1 minute of standing
  6. Hemoglobin 13.8 g/dL (138 g/L)
Show the answer and rationale

Answer: B, C, D, E

Diphenhydramine is an anticholinergic that the Beers Criteria advise older adults to avoid because it causes confusion, urinary retention and falls, and a systolic drop of 24 mm Hg on standing meets the definition of orthostatic hypotension (a fall of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes). Nighttime urgency sends clients hurrying to the bathroom in the dark, and a sodium of 128 mEq/L, which pneumonia can cause through SIADH, impairs attention and gait and raises the risk of falling even when the client has no other symptoms. A hemoglobin of 13.8 g/dL is normal, and calcium with vitamin D protects bone without raising the risk of falling.

📚 Learn it: Falls: Bed Low, Wheels Locked, Call Light in Reach

Practice SATA and Next Gen items free →

Every set mixes SATA, matrix, cloze, bowtie and highlight items, scored by NCSBN's rules. No ads, no trial, no card.

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❓ Frequently asked

How is SATA scored on the NCLEX?

Plus/minus: one point for each correct option you select, one point deducted for each incorrect one, never below zero for the item. The maximum equals the number of correct options.

Should I guess on SATA options?

Only when you can defend the option. A wrong extra option costs the same point as a missed correct one, so an unjustified guess has no expected gain.

How many answers are correct on a SATA question?

Anywhere from one to all of them. NCSBN publishes no minimum, so judge each option on its own.

Can I get partial credit on SATA?

Yes, since the Next Generation NCLEX launched in April 2023. Partial credit applies to every item with more than one correct response.

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Sources

  1. NCSBN, NCLEX-RN Test Plan effective April 2026 (categories, 85–150 items, case studies, scoring methods, how the exam ends)
  2. NCLEX.com, Frequently Asked Questions (scoring rules, no going back, Quick Results)
  3. NCSBN, Next Generation NCLEX test design (2021 Midyear Meeting slides): item types, 52 + 18 + 15 structure, +/− and 0/1 scoring
  4. NCSBN, Next Generation NCLEX News, Summer 2021: scoring models by item type
  5. NCLEX.com, Prepare: candidate tutorial, exam preview and NGN sample pack

Accessed October 2026. Yearly figures name their year; NCSBN publishes a new statistics brief each June and a new test plan every three years (next: April 2029). Exam preparation only, never medical advice. NCLEX® is a registered trademark of NCSBN, which does not endorse this site.

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