NCLEX Select All That Apply Questions

What a SATA question looks like

SATA presents the candidate with a stem and 5 to 6 answer options, each with an independent checkbox. Two or more options are correct. The candidate is not told how many are correct, so each option must be evaluated on its own merit against the case.

The question stem usually ends with the phrase "Select all that apply" or "The nurse should plan to include which interventions? Select all that apply."

The +/- partial-credit scoring rule

On the Next Generation NCLEX, SATA items use a partial-credit scoring rule that rewards correct selections and penalizes wrong selections independently.

Three rules follow from this formula:

• A checked correct option earns +1. Every correct option you identify adds to your score.
• A checked incorrect option earns -1. Every wrong option you check subtracts from your score.
• An unchecked option scores zero. Whether the unchecked option was correct or incorrect, leaving it blank neither helps nor hurts directly. You forfeit the +1 if it was correct, but you do not lose a -1.

The minimum score is floored at zero. If you check 1 correct and 3 wrong on an item with 4 correct options, your raw math says -2, but you score 0.

Worked scoring scenarios

Assume an item has 6 options, with 3 correct and 3 incorrect. The maximum raw score on the item is 3.

Notice that checking 1 correct option plus 1 wrong option nets to zero. The candidate has done work and gained nothing. This is why guessing on SATA is mathematically worse than abstaining.

How SATA scoring changed on the NGN

On the pre-2023 NCLEX, SATA used all-or-nothing scoring: you had to check every correct option and no incorrect options to earn the point. Missing one correct option scored you zero on the item. Checking one extra incorrect option scored you zero on the item.

The NGN +/- rule is much more forgiving. A candidate who confidently identifies 3 of 4 correct options now earns 3 raw points instead of 0. This change rewards clinical knowledge even when the candidate is not 100% certain about the full set of correct answers.

Worked example

Here is a SATA item modeled on the ones in the NCLEX Simulator question bank.

Four options are correct findings for dehydration. The temperature and lethargy are signs of the underlying illness, not specific to dehydration itself. A candidate who checks the four correct findings and leaves the other two blank earns 4 of 4 raw points. A candidate who also checks lethargy out of caution earns 4 minus 1, or 3 of 4.

SATA strategy that follows from the math

The +/- scoring rule changes the optimal strategy compared to the old all-or-nothing days. Three principles:

• Evaluate each option as a standalone true-or-false statement. Do not compare options to each other. Ask whether each option is a true statement about the case, in isolation.
• When uncertain, lean toward leaving an option unchecked. An unchecked correct option costs you +1 you would have earned. A checked incorrect option costs you a -1 from your existing positive total. The asymmetry favors restraint.
• Never check an option because you think you should have a certain count. The number of correct options is not stated and varies by item. Some items have 2 correct out of 5. Some have 5 correct out of 6. Trying to hit an expected count is how candidates check distractors.

What students get wrong on SATA

• Treating SATA like a multiple-choice item. SATA has no single best answer. Comparing options to find the most-correct one is the wrong frame.
• Assuming half the options must be correct. The correct count varies. There is no rule that says 3 of 6 are correct.
• Checking borderline options for safety. Under the +/- rule, a borderline check costs a guaranteed -1 in exchange for a risky +1. The math does not favor it.
• Forgetting that unchecked correct options forfeit points. The opposite mistake: under-checking out of fear. If you are confident an option is correct, check it. Confidence is the right threshold, not certainty.