Question formats
Ten formats, three scoring rules
The format is not decoration. It determines how points are awarded, and that changes how you should answer. On a plus-minus item, a guess you are unsure about is a coin flip that can cost you a mark you already earned. On an all-or-nothing item, a blank is identical to a wrong answer, so there is never a reason to leave one.
| Format | Scoring | Strategy |
|---|---|---|
| Multiple choice One best answer from four or more options. Still the backbone of every exam. | All or nothing | Name the clinical task before reading options: assessment, priority, action, teaching or evaluation. |
| Select all that apply Choose every correct option. Extended multiple response versions may cap the number you can select. | Plus / minus | Treat each option as its own true/false question against the scenario. Do not hunt for a pattern in the count. |
| Matrix / gridNGN A grid where each row needs a decision. Round selectors mean one answer per row; square selectors mean several. | Plus / minus | Work one row at a time, holding the same scenario in mind. Never leave a row blank — partial credit is real. |
| Cloze (drop-down)NGN Fill in the blanks of a clinical sentence using context-sensitive drop-down lists. | All or nothing | Read the entire sentence before touching any drop-down. Later blanks constrain earlier ones. |
| HighlightNGN Click the findings in a chart note or table that require follow-up. Everything else is distractor. | Plus / minus | Highlight only findings that would change your nursing action. Abnormal but expected is not the same as concerning. |
| Extended drag and dropNGN Drag responses into targets. Not every token has a home — some are deliberately unused. | Plus / minus | Fill the targets you are certain of first. The remaining tokens narrow themselves by elimination. |
| Bow-tieNGN A single stand-alone item that measures all six clinical-judgment steps at once: condition in the centre, actions on the left, parameters to monitor on the right. | Plus / minus | Solve the centre first. Once the condition is named, the actions and monitoring parameters follow. Guessing the wings without the condition is close to hopeless. |
| TrendNGN Serial data across several time points. The question is the direction of travel, not any single value. | Plus / minus | Read columns left to right and label each parameter improving, worsening or unchanged before answering. |
| Ordered response Place steps of a procedure or priority sequence in the correct order. | All or nothing | Anchor the first and last steps, then fill the middle. Safety and assessment steps almost always lead. |
| Calculation Type a numeric answer: dosage, IV rate, intake and output, or titration. | All or nothing | Write the units at every step. Most lost marks are conversion errors, not arithmetic errors. |
All or nothing
Every part must be right. Cloze and ordered-response items work this way — one wrong drop-down zeroes the whole item, which is why you read the full sentence before touching any of them.
Plus / minus
Each correct selection adds a point, each incorrect one subtracts a point, and the item floors at zero. This is why selecting everything on a select-all question scores zero rather than full marks.
Rationale scoring
A two-part item where the second half only earns credit when the first half is right. Cause and effect are bound together, because a correct intervention chosen for the wrong reason is not clinical judgment.