NCLEX-RN cheat sheet · Exam strategy

NGN item types and how they're scored

Highlight, matrix, drop-down, select all, select N, grouping, drag and drop, ordered, bowtie, trend and calculation items

AI-checkedChecked by AI against current guidelines, with spot-checks by a registered nurse.

Know which rule scores the item before you click. Under plus-minus, each wrong pick takes a point; under zero-one, a wrong pick earns nothing and costs nothing extra. The filter in the stem decides every click.

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At a glance

Item types and their scoring rule

Item type	What you do	How it's scored	A wrong pick
Highlight (enhanced hot spot)	Click set phrases in part of a record. Text you can't select is context	Plus-minus, never below zero. NCSBN's scoring article doesn't name highlight items; its general rule covers them	Takes a point
Matrix multiple choice	One answer per row, like a radio button	Zero-one, row by row	Earns nothing, takes nothing away
Matrix multiple response	One or more marks per row, like a checkbox	Plus-minus, column by column; each column stops at zero on its own	Takes a point in that column
Drop-down (cloze), in a sentence or table	Pick one choice from each list	Zero-one: each drop-down is its own point	Earns nothing, costs nothing anywhere else
Drop-down rationale pair	One blank gives the reason for the other: action X because of Y	Both must be right to earn the point	The pair earns nothing
Select all that apply; extended multiple response	One or more options are correct; extended has more options to judge	Plus-minus; a right option left out earns nothing; never below zero	Takes a point
Select N	Choose exactly N; the screen won't let you choose more	Zero-one	Earns nothing, but crowds out a right one
Grouping	Select within each group, often one group per client	Plus-minus, one group at a time; each group stops at zero	Takes a point in its group
Extended drag and drop	Drag tokens into targets; there may be more tokens than targets	Not named in NCSBN's scoring guide: expect each target scored on its own	Expect it to cost only that box
Ordered response	Put every option in sequence, first to last	NCSBN publishes no rule. This course's practice items score an order as all or nothing	Treat every position as mattering
Bowtie	2 actions, 1 condition, 2 parameters; drag choices from pools	Zero-one, box by box; always worth 5 points	Earns nothing, costs nothing else
Calculation (fill-in)	Type a number into a box	No partial credit for being close	The number is right or it isn't

Partial credit counts: NCSBN says partial credit feeds the adaptive scoring, so every right blank helps. A highlight item can stand alone, or appear as one screen of a case study.

Before you click

Read the instructions: which kind of matrix is it? Read the filter in the stem before the note. Key words like increased, refute and support are in bold.
Treat every option as true or false for this client, against the stem, before you look at the others.
Never decide by counting. Select all can have a single right option. Answers landing three and two across columns means nothing.
Select only what you can defend. Unsure on a highlight item? Leave it.
Unsure on an ordinary drop-down? A wrong guess there costs nothing extra, so answer and move on.
Every row (choice matrix) or every column (response matrix) must be answered before the screen moves on.

Score it yourself

Item	You pick	Score
Highlight	2 right, 1 wrong	1
Highlight	0 right, 3 wrong	0 (floor)
Select all	Both right, plus 3 wrong	0 (floor)
Select 3	2 right, 1 wrong	2
Matrix choice, 6 rows	4 rows right, 2 wrong	4
Response column	3 right, 2 wrong	1
Rationale pair	Right action, wrong reason	0
Bowtie	Wrong condition, other 4 right	4 of 5

Bowtie method

Condition in the middle: what the client is most likely experiencing. Actions: what to do now. Parameters: what to watch, to know if it's better or worse.
Either action can go in either action box; the same for parameters. Each side takes exactly two, so every wrong pick pushes out a right one.
Anchor the middle first. Use a cue from the chart to make each wrong condition unlikely. Actions treat it; parameters track it. Read it back as one sentence.

Calculation items: NCSBN's rules

The item states the precision: a whole number, or one or two decimal places. When decimals are asked for, type the decimal point.
Round only at the end. Look one place past the one you're keeping: 5 or more rounds up, under 5 rounds down.
On-screen calculator and a noteboard; no handheld calculators or conversion tables. Conversions, like 2.2 pounds to a kilogram, are on you.

Trend items: data over time

NCSBN's current pages don't define a trend item, so treat the label loosely. It's data over time, answered in a familiar format: a matrix, a select-all, a drop-down or a highlight.
Read three points: baseline, what was done, and now. For each finding: better, worse, or unchanged, compared with this client's own start. Then ask whether it's enough.
Improving isn't the same as normal, and normal isn't the same as fine. A number held up by more support, like more oxygen, hasn't really improved.

Priority and safety calls

★ Plus-minus items: picking extras just in case costs a full point each. Highlighting everything abnormal is the trap.
Response matrix: a row can belong to more than one column. One mark per row loses points.
Select N: a wrong pick pushes out a right one, so choose the ones you're most sure of.
★ Rationale pair: choose the because first, then the action it justifies. A reason that's true isn't enough; it has to be the reason for this action.
Drag and drop: leftovers are normal. Don't force every token into a box.
Ordered response: find the first and the last, then fill the middle. Order by safety, not habit.
Highlight: judge for this client. Times and baselines, like up from, down from and since 0400, are often the point.

How the NCLEX tests it

Highlighting is scored plus-minus with a floor of zero; the filter decides every click, and plain text is context.
Matrix choice is zero-one per row; matrix response is plus-minus per column.
Ordinary drop-downs are zero-one each. A rationale pair is both or nothing.
Select all and extended are plus-minus; select N is zero-one; grouping is plus-minus, group by group.
Bowtie: five boxes, zero-one each, five points. Middle first.
Calculation: the item sets the precision. Type the decimal point. Round only at the end.

Practice it next

This sheet comes from How highlight items work and how they're scored and Matrix multiple choice vs multiple response and Cloze, table and rationale drop-downs and Select all, select N, grouping, and the +/− trap and How drag-and-drop and ordered items work and How bowtie items work and how they're scored and Reading data over time and NCSBN's calculation rules in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.

Free NCLEX practice questions The NCLEX-RN course

Quick self-quiz

NCSBN calls highlight items enhanced ___.
Show answer
hot spot
Matrix multiple response is scored plus-minus, column by ___.
Show answer
column
In a rationale pair, the right action with the wrong reason earns ___.
Show answer
nothing
A select-all item can't score below ___.
Show answer
zero
A bowtie is always worth ___ points.
Show answer
5
Rounding to the nearest tenth, 1.249 is entered as ___.
Show answer
1.2

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Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.